Liaoyang Urban Resident Medical Insurance

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Liaoyang Municipal People's Government Order No. 102 "Liaoyang Urban Resident Basic Medical Insurance Measures" was discussed and adopted at the 2nd executive meeting of the 14th Liaoyang Municipal People's Government on April 16, 2008, and is hereby issued. Release implementation. Mayor Tang Zhiguo issued Article 1 on April 28, 2008, in order to further improve the medical insurance system, establish a medical security system covering urban residents, and ensure the basic medical needs of urban residents, in accordance with the provisions of relevant laws, regulations, and rules, and in combination with the actual situation of our city. , formulate these measures. Article 2 These Measures shall apply to urban non-employed persons outside the coverage of the urban employee basic medical insurance system within the municipal coordination area of ??our city (hereinafter referred to as the "urban area") who participate in the urban resident basic medical insurance. Article 3 The term “Urban Residents Basic Medical Insurance” (hereinafter referred to as “Urban Residents Medical Insurance”) as mentioned in these Measures refers to the insurance system under which individual residents and the government bear specific outpatient and inpatient medical expenses according to a certain proportion under the organization of the government and its departments. . Article 4 Urban residents' medical insurance shall be organized and implemented by the government and relevant departments. It shall start at a low level, focus on ensuring the medical needs of serious diseases, and gradually improve the level of protection. Expenditures shall be determined and balanced based on revenue, and participation shall be voluntary and the rights and obligations of insured residents shall be equal. and the principle of raising funds through multiple channels in line with the level of economic development and residents’ affordability. Article 5 The municipal labor and social security administrative department is the administrative department for urban residents’ medical insurance in our city (hereinafter referred to as the “medical insurance department”) and is responsible for the policy formulation, organization, implementation, supervision and management of urban residents’ medical insurance. Its affiliated medical insurance agency (hereinafter referred to as the "medical insurance agency") is specifically responsible for undertaking daily work such as the examination and approval of insurance qualifications for urban residents' medical insurance in the coordinated area, fee collection, medical expense payment, and medical treatment management. Departments and units such as finance, health, civil affairs, education, public security, and the Disabled Persons' Federation are responsible for the relevant work of urban residents' medical insurance within their respective scope of responsibilities. Article 6 Residents with urban household registration in our city (hereinafter referred to as "residents") who meet one of the following conditions can participate in urban resident medical insurance: (1) Students in full-time primary and secondary schools (including secondary vocational schools) and those aged 0 to 18 years old Other residents; (2) Men over 18 years old and under 59 years old, women over 18 years old and under 49 years old, subsistence allowance recipients, subsistence allowance marginal households, and non-employed residents with severe disabilities of level 2 or above; (3) Those who do not enjoy the benefits Pensions and pension benefits for men over 60 years old and women over 50 years old are not covered by the urban employee basic medical insurance. Medical insurance for college students is implemented in accordance with relevant national and provincial regulations. Article 7 Sources of urban resident medical insurance funds: (1) Basic medical premiums paid by insured residents; (2) Municipal and district government subsidy funds; (3) Late payment fees collected in accordance with regulations; (4) Interest income from the fund; (5) ) shall be included in other income of the medical insurance fund in accordance with the law. Article 8 The annual medical insurance expenses for urban residents are jointly borne by individual residents and the government according to the following proportions: (1) Individual minors pay 40 yuan and the government subsidizes 40 yuan. Among them, those on the minimum living allowance pay 16 yuan individually and receive a government subsidy of 64 yuan; those on the margins of the minimum living allowance pay 30 yuan individually and receive a government subsidy of 50 yuan. (2) Minimum living allowance personnel within the working age group and non-employed residents with severe disabilities of level 2 or above shall pay 180 yuan individually and receive a government subsidy of 120 yuan; those on the margins of the minimum living allowance within the working age group shall pay 210 yuan individually and receive a government subsidy of 90 yuan. (3) Elderly residents shall pay 200 yuan individually and receive a government subsidy of 100 yuan. Among them, people living on subsistence allowances and the elderly with severe disabilities of level 2 or above pay 80 yuan individually and receive a government subsidy of 220 yuan; elderly people on the margins of subsistence allowances pay 160 yuan individually and receive a government subsidy of 140 yuan. For insured residents’ hospitalization medical expenses within one calendar year (students are calculated based on the academic year), the overall fund payment limit is 30,000 yuan (including inpatient and outpatient prescribed disease expenses).

Article 9 Residents who meet the conditions for urban resident medical insurance should go to their community to go through the insurance registration procedures with the following certification materials: (1) 2 copies each of household registration book and ID card; (2) 4 recent one-inch photos without a hat; ( 3) Certificate for receiving subsistence allowance amount or certificate for assistance to marginalized households; (4) Certificate for persons with disabilities. If an incapacitated person or a severely disabled person is unable to handle registration in person, his guardian or his/her client shall handle the registration on his or her behalf. The community should accept and review the insurance enrollment procedures submitted by residents in a timely manner. If the materials are incomplete, residents should be notified on the spot of all the necessary supplements and corrections. If the materials are complete and meet the insurance conditions, they should be reported to the sub-district office within 3 days from the date of acceptance. The sub-district office will summarize and report to the district labor and social security department for approval; if the conditions are not met, residents should be informed in writing. The district labor and social security department shall review the registration information received within 7 days. If the conditions are met, the relevant information shall be summarized and submitted to the medical insurance institution. Students’ insurance registration, information collection, declaration and verification, information changes and other insurance matters are organized by their school. Article 10 After the insured residents register for insurance, they should go to the financial institution designated by the medical insurance authority within the designated payment period with the "Payment Notice" issued by the community from October 1 to November 30 every year. Pay in full the medical premiums payable for the current period. Students' medical insurance premiums are collected by the medical insurance agency assisted by their school. Article 11 Medical insurance institutions shall, within 30 days of the resident payment deadline, prepare an "Urban Resident Medical Guarantee" and medical cards for insured residents based on relevant summary information, and issue them to insured residents through the community. Article 12 Those who move to urban areas of our city after the implementation of these Measures can participate in urban residents' medical insurance in accordance with the provisions of these Measures. The insurance premiums will not be eligible for government subsidies within 2 years. This measure does not apply to persons who enjoy pension or pension benefits in other places. Article 13 Residents who participate in urban resident medical insurance shall not participate in urban employee basic medical insurance or new rural cooperative medical care at the same time. Those who have participated in the urban employee basic medical insurance are not allowed to participate in the urban resident medical insurance. If the status of residents participating in urban resident medical insurance changes, they can participate in urban employee basic medical insurance after the insurance is suspended. If residents switch to other forms of social medical security after participating in the insurance, or their household registration moves out or is cancelled, the insurance relationship will be terminated automatically and the fees paid will not be refunded. Article 14 Government subsidy funds shall be borne by the municipal and district governments in a ratio of 5.5:4.5. The amount of subsidy can be adjusted in a timely manner according to the financial status of the two levels. Employers with conditions may provide appropriate subsidies for the personal contributions of employees' family members. Article 15 Government subsidy funds will be included in the fiscal budget and will be allocated proportionally within 30 days by the municipal and district finance departments based on the data compiled by the medical insurance institutions after the residents’ medical premiums are paid in full and on time. Subsidy funds are uniformly transferred to the urban residents' medical insurance co-ordination fund account. Article 16 Residents who pay for insurance within 3 months from the date of obtaining insurance qualifications will enjoy basic medical insurance benefits starting from the month after payment. If you meet the insurance conditions before the implementation of these measures but fail to participate in the insurance within the prescribed period, and if you apply for insurance payment more than 3 months after obtaining the insurance qualifications, your household registration will be moved to our city from other places after the implementation of these measures and you will be eligible for the first time participation. For those who meet the insurance conditions, after participating in the insurance and paying the premium, the waiting period for their benefits is 6 months. After the waiting period expires, they can enjoy medical treatment. Article 17 If insured residents are unable to pay basic medical insurance premiums in full and on time, they will cease to enjoy medical insurance benefits. Payment again will be handled as re-enrollment, and the waiting period for benefits will be 6 months. Article 18 When insured residents are hospitalized or receive outpatient treatment for specified diseases, the relevant national and provincial regulations on drug catalogs, diagnosis and treatment items, and service facility scope shall be followed. Article 19 If insured residents are sick and need outpatient treatment or hospitalization, they can independently choose a treatment unit among the designated medical institutions designated by the medical insurance authority. When insured residents receive medical treatment or treatment, they should go through the registration procedures with their own medical guarantee and card, and they or their relatives or guardians should sign on the admission registration form. If you fail to use your medical guarantee and card to register for hospitalization in time due to emergency hospitalization, you must submit your medical guarantee and card to a designated medical institution within 24 hours to complete the hospitalization registration procedures. If you fail to use your own medical insurance card or card to handle hospitalization procedures in accordance with regulations, the medical expenses incurred shall not be paid from the medical insurance fund.

Article 20 The minimum payment standard for medical expenses incurred by insured residents for hospitalization shall be as follows: (1) 100 yuan for minor residents hospitalized in community medical institutions, 200 yuan for minor residents hospitalized in first-level medical institutions, and 200 yuan for minor residents hospitalized in second-level medical institutions. Those hospitalized in first-level medical institutions are 300 yuan, and those hospitalized in tertiary medical institutions are 500 yuan; (2) Adult residents and elderly residents hospitalized in community medical institutions are 200 yuan, and those hospitalized in first-level medical institutions are 300 yuan; Hospitalization in secondary medical institutions is 400 yuan; hospitalization in tertiary medical institutions is 500 yuan. (3) 700 yuan for patients who are treated in non-designated medical institutions due to emergencies or who are transferred to other places for treatment upon approval. If an insured resident is hospitalized multiple times in the same calendar year, the minimum payment standard will not be reduced. If the medical expenses are below the minimum payment standard, they will be paid by the individual. Article 21 There is no minimum payment standard for patients with mental illness, hepatitis B, or tuberculosis who are hospitalized in designated specialized medical institutions. Article 22 If insured residents are hospitalized in designated medical institutions and meet the prescribed medical expenses, if they are above the minimum payment standard and below the maximum payment limit, they will be shared according to the following proportions: (1) If they are hospitalized in community health service institutions, the overall fund will be used to pay 60%, personal burden 40%. (2) If you are hospitalized in a first-level hospital, the overall fund will pay 55% and the individual will bear 45%; (3) If you are hospitalized in a second-level hospital, the overall fund will pay 50% and the individual will bear 50%; (4) If you are hospitalized in a third-level hospital , the overall fund will pay 45%, and the individual will bear 55%; Article 23 If the insured residents need to be transferred to a higher-level medical institution for treatment, they should go through the referral and transfer procedures at the designated medical institution designated by the medical insurance agency. For medical expenses incurred out of the hospital, the payment ratio of the overall fund will be reduced by 5% according to the payment ratio of medical institutions of the same level. Article 24 If insured residents do not receive treatment in designated medical institutions in the city or transfer to other medical institutions for treatment without approval, the medical expenses incurred shall not be paid from the medical insurance fund. Article 25 Insured residents suffering from prescribed diseases in outpatient clinics should go to the medical insurance agency to go through procedures such as confirmation of prescribed diseases, application for benefits, and selection of medical treatment. Measures for the management of prescribed diseases in urban residents’ medical insurance outpatient clinics shall be formulated separately by the competent medical insurance department. Article 26 If an insured resident has any of the following circumstances, the medical expenses incurred will not be paid from the medical insurance pooling fund: (1) Treatment abroad or in Hong Kong, Macao and Taiwan; (2) Fighting, Injuries caused by self-mutilation, suicide, drug abuse and other illegal crimes and alcoholism; (3) Injuries caused by traffic accidents, medical accidents, etc. Article 27 Designated medical institutions for urban residents’ medical insurance shall be determined by the competent medical insurance department in accordance with prescribed conditions. If it is determined to be a designated medical institution, the door number of the designated medical institution issued by the medical insurance authority shall be hung in a prominent position of the institution. Article 28 Medical insurance institutions shall sign agreements with designated medical institutions on matters related to the implementation of urban residents’ medical insurance and medical care, clarifying the responsibilities, rights and obligations of both parties. When designated medical institutions carry out medical work, they should promptly provide the insured residents with a detailed list of the day's medical expenses. Article 29 Designated medical institutions shall charge according to the charging items approved by the relevant departments, and shall clearly mark the prices, and shall not use unqualified prescriptions, documents and accounting statements; shall not admit imposters to the hospital; shall not exchange diseases or treat diseases that do not belong to The diseases, drugs and services in the "Diagnosis and Treatment Items", "Drug Catalog" and "Service Facilities Scope and Payment Standards" are included in the payment scope of the medical insurance overall fund; examination, treatment, medication or work conveniences shall not be carried out beyond the needs of the patient's condition Prescribe medicines in the name of insured residents. Article 30: Insured residents are not allowed to lend their medical insurance and cards to others for medical treatment, and are not allowed to forge or alter medical insurance or cards. Violators will have their medical insurance benefits suspended and will not be allowed to participate within 2 years in addition to recovering medical expenses. Medical insurance for urban residents. Article 31 The competent department of medical insurance shall supervise and inspect the handling of medical insurance and diagnosis and treatment for urban residents by medical insurance agencies and designated medical institutions, and shall deal with violations of these regulations in a timely manner. Insured residents and other members of society have the right to supervise the income and expenditure of urban medical premiums, benefits and medical services in designated medical institutions. If they believe that there is illegal behavior, they can report it to the medical insurance authority. The medical insurance authorities shall accept reports in a timely manner and promptly adjust and handle them in accordance with the law.

If the circumstances are serious enough to constitute a crime, the case shall be transferred to judicial organs for criminal liability. Article 32 The Urban Resident Medical Insurance Co-ordination Fund shall be managed through a special financial account, and shall be used exclusively for special purposes. No unit or individual may misappropriate the fund. Article 33: The civil affairs department shall formulate separate measures in conjunction with relevant departments on the medical assistance issues for the insured residents who are living under the minimum living allowance and those living in marginal households receiving the basic medical insurance after enjoying the basic medical insurance benefits. Article 34 When participating in urban resident medical insurance, they must also participate in over-limit supplementary medical insurance. Specific measures will be formulated separately. Article 35: Adjustments to the financing standards, government subsidy standards, overall fund minimum payment standards, maximum payment limits and payment proportions of urban residents' medical insurance shall be made by the medical insurance administrative department in a timely manner based on the financing and operation of the medical insurance fund in the previous year. It will be implemented after being reported to the municipal government for approval. Article 36 For non-employed urban residents, adult residents and elderly residents under the age of 18 who participated in the insurance for the first time in 2008, the insurance period is from July 1 to September 1, and the medical insurance premiums are based on one quarter of that year. Collect and enjoy one quarter of urban residents' medical insurance benefits from October 1, 2008 (the minimum payment standard for hospitalization is halved). School students who participate in insurance for the first time must pay 4 months of basic medical insurance premiums for urban residents, and at the same time prepay the medical insurance premiums for the next year. The treatment standard is calculated based on 1/3 of the maximum payment amount of the annual unified fund, and the minimum payment standard for hospitalization is reduced. Half. Article 37 The urban resident medical insurance fund in Baita District, Wensheng District, Hongwei District and Taizihe District shall be coordinated by the municipal level. The medical insurance measures in Liaoyang County, Dengta City, and Gongchangling District are formulated by the counties (cities) and districts themselves. Article 38 These Measures shall come into effect on July 1, 2008.