Measures for mutual medical insurance for employees of Wuhan Federation of Trade Unions

The Implementation Rules for Medical Mutual Assistance for Retirees in Wuhan City are to cooperate with the reform of the basic medical system for urban employees in Wuhan City and promote the establishment and improvement of a multi-level medical security system, fully carry forward the glorious tradition of solidarity and mutual assistance of the working class, and help employees reduce hospitalization To reduce the medical burden, improve the level of medical security, and promote the construction of a harmonious society in our city, these implementation rules are formulated. Mutual Aid Objects Article 1 Retirees who have participated in Wuhan Urban Employees Basic Medical Insurance and Large Medical Insurance (hereinafter referred to as participants) can participate in this mutual aid activity as a group under the unified organization of the labor union of their unit. Mutual Assistance Period Article 2 The period of mutual assistance activities in this period is one year, starting from January 1, 2022, and ending on December 31, 2022. Participation method Article 3 adopts a group membership system. Participants will be uniformly organized to pay the mutual aid fee by the labor union of their unit (hereinafter referred to as the participating unit), and then go to the Wuhan Employee Medical Mutual Aid Office (hereinafter referred to as mutual aid) from the union of the district, bureau (head office), and directly affiliated large unit (hereinafter referred to as the agency unit). (Office) to handle the participation procedures in a unified manner. Retirees can only participate in this year's "Wuhan Municipal Employees' Inpatient Medical Mutual Aid Activities" or "Wuhan Municipal Employees' Comprehensive Medical Mutual Aid Activities" when the current employees of the unit participate in this year's "Wuhan Municipal Employees' Comprehensive Medical Mutual Aid Activities". Article 4 Participating units shall apply online. After successful application, print out the "Application Form for Participation in Wuhan Employee Hospitalization Medical Mutual Aid" and provide the unit's roster of personnel who have recently participated in the Wuhan Urban Employee Basic Medical Insurance and copies of the basic medical insurance payment vouchers. One serving. Article 5 If the participating units have paid the mutual aid fee to the Mutual Aid Office and completed the procedures for participating in this period of cooperation before February 15, 2022 (inclusive), their mutual aid is valid from 0:00 on January 1, 2022 to 2022. Ending at 24:00 on December 31; if the procedures for participating in this period of cooperation are applied after February 15, 2022, the validity period of the cooperation is from 0:00 on the next day after paying the mutual aid fee to the Mutual Aid Office and completing the procedures for participating in this period of cooperation. Until 24:00 on December 31, 2022, and the mutual aid fees will still be paid in accordance with the payment standards stipulated in these implementation rules. Within the validity period of mutual aid after the start of mutual aid activities, participating units generally cannot apply for additional participation procedures for retirees of the unit who have not participated. Article 6 After participating in mutual aid activities, participating units should notify the Mutual Aid Office in writing within 15 days after the change of the unit’s basic information (unit name, address, postal code, contact person and contact number, etc.). Payment standards Article 7: The ratio of retirees participating in this mutual aid activity to the current employees of the unit participating in the "Wuhan Municipal Employees' Inpatient Medical Mutual Aid Activities in 2022" or the "Wuhan Municipal Employees' Comprehensive Medical Mutual Aid Activities in 2022" is less than 1.5 times In a unit, the mutual aid fee paid by retirees in this period is 310 yuan per person per share; in a unit with 1.5 times (including 1.5 times) to 2.5 times, the mutual aid fee paid by retirees in this period is 370 yuan per person per share. Mutual aid fees should be paid in one lump sum. Once the mutual aid fee is paid, it is not refundable. Participants can only participate in one share within a cooperation period, and the excess share will be deemed invalid. Mutual Aid Responsibilities Article 8 Participants can enjoy medical mutual aid subsidies if they are hospitalized in a medical insurance designated hospital within the validity period of mutual aid. Article 9 During the validity period of mutual assistance, when the liability of basic medical insurance and large-amount medical insurance to participating units or participants terminates, this mutual assistance liability will terminate. Article 10 Mutual assistance responsibilities shall terminate upon expiration of the mutual assistance period. Benefit Standards Article 11 During the validity period of mutual aid, when a participant is hospitalized in a designated hospital for medical insurance and incurs medical expenses that comply with the provisions of basic medical insurance, after the settlement and payment of basic medical insurance and large-amount medical insurance, the medical expenses paid by the individual out of pocket Expenses (excluding deductibles, out-of-pocket expenses and over-limit expenses) are calculated on a segmented basis to pay the medical mutual aid fund (the medical mutual aid fund is rounded to the nearest dollar).

Specifically: for the part below 10,500 yuan (inclusive of 5,000 yuan), the medical mutual aid subsidy will be paid at a rate of 20; for the part between 20,500 yuan (exclusive of 5,000 yuan) and 10,000 yuan (inclusive of 10,000 yuan), The medical mutual aid subsidy will be paid at RMB 30; the medical mutual aid subsidy will be paid at RMB 50 for the portion between RMB 31,000 (excluding RMB 10,000) and RMB 50,000 (inclusive); and the mutual aid subsidy will be paid at RMB 45,000 (excluding RMB 50,000) to RMB 100,000. For the portion of 51,000 yuan (including 100,000 yuan) to 120,000 yuan (including 120,000 yuan), the medical mutual aid subsidy will be paid at 80%. Article 12 Within the validity period of a mutual aid, the payment of medical mutual aid funds is not limited by the number of times, and is handled separately for each discharge, and there is no cumulative double calculation. Article 13 If a participant has been hospitalized before participating in this mutual aid activity and is discharged during this mutual aid period; or if a participant is hospitalized during this mutual aid period and is discharged only after the expiration of this mutual aid period and does not participate in the next mutual aid activity, his/her medical treatment The mutual aid fund is calculated by multiplying the proportion of the number of hospitalization days within the validity period of the mutual aid to the total hospitalization days (the day of discharge is not included in the total hospitalization days) multiplied by the personal out-of-pocket medical expenses (excluding deductibles, self-pay expenses and over-the-counter expenses). Limit fee) to calculate the payment base, and then calculate the medical mutual aid benefits according to the payment standards in the current mutual aid implementation rules. If a participant is hospitalized during this mutual aid period and is discharged after the mutual aid period expires and has participated in the next phase of mutual aid activities, the calculation method of the medical mutual aid fund is: the number of days of hospitalization within the validity period of the two phases of mutual aid accounts for the total number of days of hospitalization (the day of discharge) (not included in the total days of hospitalization) is multiplied by the personal out-of-pocket medical expenses (excluding deductibles, out-of-pocket expenses and over-limit expenses) to calculate the benefit base, and then calculate the benefit base according to the payment standards of the two phases of mutual aid implementation details. Pay medical mutual aid. Mutual Aid Benefits Article 14 Inpatient medical mutual aid benefits will be settled in "one-stop" settlement at relevant medical insurance designated hospitals in our city. When participants handle discharge settlement at relevant medical insurance designated hospitals in our city, they will simultaneously settle inpatient medical mutual aid funds. The mutual aid funds they should enjoy will first be offset against personal out-of-pocket expenses within the scope of medical insurance. If there is a balance, it will continue to be offset against personal out-of-pocket expenses. Article 15 While adopting "one-stop" settlement for hospitalization medical mutual aid funds, in the following situations, the mutual aid office will use the mutual aid office to obtain the hospitalization settlement information of employees participating in the mutual aid, and generally calculate and review it within 2 working days, and the hospitalization will be The way in which the medical mutual aid fund is directly transferred to the participant's personal social security card bank account: 1. Hospitalization in a hospital that is not included in the "one-stop" settlement or a hospital in another place; 2. The hospitalization medical mutual aid fund is higher than that of an individual within the scope of the hospitalization medical insurance. Out-of-pocket expenses and the total of out-of-pocket expenses; 3. Not enjoying employee medical insurance benefits when discharged from hospital, and then settled at our city's medical insurance agency; 4. Other situations that require direct review and payment. Exclusions Article 16 If the following circumstances occur, we will not be responsible for the payment of medical mutual aid funds: 1. Inpatient medical expenses incurred outside the validity period of mutual aid; 2. During the validity period of mutual aid, when the participant is hospitalized in a designated hospital for medical insurance, any medical expenses incurred For medical expenses that comply with the provisions of basic medical insurance, after the settlement and payment of basic medical insurance and large-amount medical insurance, the cumulative total personal out-of-pocket medical expenses (excluding the minimum payment line, self-pay expenses and over-limit expenses) exceeds 120,000 yuan; 3. Medical expenses for work-related injuries (occupational diseases) and childbirth for female employees; 4. Hospitalization medical expenses that are not covered by basic medical insurance and large-amount medical insurance; 5. Retirees from non-participating units; 6. Using various fraud and cheating behaviors Fraudulent medical mutual aid funds. Article 17 If a participating unit or participant commits any act mentioned in paragraph 6 of Article 16, its mutual aid responsibilities will be terminated immediately, the medical mutual aid funds paid will be recovered, and the relevant unit trade unions and responsible persons will be held accountable. Supplementary Provisions Article 18 The Wuhan Municipal Employee Medical Mutual Aid Office is responsible for interpreting these implementation rules. Article 19 These implementation rules will come into effect on January 1, 2022.