Policy Interpretation of "Detailed Rules for the Implementation of Medical Security for Key Special Care Groups in Wangcheng District of Changsha City"

In order to ensure the medical treatment of key entitled groups, these rules are formulated in accordance with the spirit of the Regulations on Pensions and Preferential Treatment for Soldiers and the Measures for Medical Security of Key Entitled Groups (Minfa [2007]101No.) and combined with the actual situation in our region. The following is my "Interpretation of the Implementation Rules and Policies of Medical Security for Key Special Care recipients in Wangcheng District of Changsha City", which is for reference only.

Interpretation of "Detailed Rules for the Implementation of Medical Security for Key Special Care Groups in Wangcheng District of Changsha City" I. Background Description

According to the Regulations on Pensions and Preferential Treatment for Servicemen and the Notice of Guo Fa (2007) 10 1 on Printing and Distributing the Measures for Medical Security of Special Care recipients and the relevant requirements of provinces and cities, these rules are formulated according to social development and actual needs, in order to effectively safeguard the legitimate rights and interests of key special care recipients in our region, support military and national defense construction, and promote economic construction and social stability in our region.

Second, the scope of adaptation

Disabled soldiers, survivors of martyrs, survivors of soldiers who died in the line of duty, survivors of deceased soldiers (hereinafter referred to as the "three genera"), rural demobilized soldiers, veterans who returned home sick, and retired soldiers who participated in the war and participated in the nuclear war, who have the household registration of urban and rural residents in this district and enjoy regular pension or regular quantitative living allowance within the administrative area of this district.

Three, according to the laws, regulations, rules and normative documents

1, Article 2, Article 3, Article 5, Article 6, Article 7, Article 8, Article 9, Article 10, Article1,Article 12, Article/kloc-0.

2. Articles 2, 3, 4, 5, 7, 8, 9, 10, 16, 5438+00, 12, and "Measures for Medical Security of Special Care recipients in Hunan Province"

3. The detailed rules for the implementation of medical security for key entitled groups in Wangcheng County, paragraphs 3, 4, 5, 6, 7, 8, 9, 10, 16, 5438+0, 12, 13,/kloc-.

Four. Description of main terms

These rules are divided into eight parts.

The first part: The general rules define the principles of medical security for key special care recipients. Article 3 These Measures are formulated in accordance with Article 4 of the Measures for Medical Security of Special Care Objects in Hunan Province.

Part II: Definition of medical security objects The categories of medical security objects are formulated according to Article 2 of the Measures for Medical Security of Special Care Objects in Hunan Province.

Part III: Defining the financing sources of the medical insurance fund. According to the "Hunan Province entitled groups medical security measures" fifth.

Part IV: The contents, standards and procedures of medical security clearly stipulate the contents, standards and procedures of participating in insurance, outpatient medical subsidy, hospitalization medical subsidy and old injury treatment in disabled soldiers from Grade 7 to Grade 10. Articles 7, 8, 9 and 10 are formulated in accordance with Articles 7, 8, 9 and 10 of the Measures for Medical Security of Special Care Objects in Hunan Province, combined with the actual situation in our region.

Part V: Payment and management of medical insurance fund. It stipulates the payment and management of funds. Article 13 is formulated according to Article 18 of the Detailed Rules for the Implementation of the Interim Measures for Medical Insurance in Changsha. Article 14 is formulated according to Article 12 of the Measures for Medical Security of Special Care Objects in Hunan Province.

Part VI: Organize and implement the responsibilities of the organizing and implementing units and related units. Articles 16, 17, 18 and 19 are formulated in accordance with Article 12 of Hunan Province's Measures for the Medical Security of Special Entitled Persons, and Article 20 is based on Article1of Hunan Province's Measures for the Medical Security of Special Entitled Persons.

Part VII: Legal responsibilities: clarify the legal responsibilities of relevant units, staff and special care recipients. Articles 2 1, 22, and 23 are formulated according to Article 13 of the Measures for Medical Security of Special Care recipients in Hunan Province.

Part VIII: The Supplementary Provisions stipulate the interpretation authority and implementation date of these Detailed Rules.

Verb (abbreviation of verb) Other problems that need to be explained.

After many discussions and revisions, the detailed implementation rules are as follows:

1, the detailed rules for implementation shall be drafted by the District Civil Affairs Bureau;

2, organized by the office of the district government held a district government executive meeting to discuss and put forward amendments (civil affairs, people's society, finance to participate in the discussion);

3, the District Civil Affairs Bureau according to the revised opinions, sent to the Legislative Affairs Office of the district government for review;

4. Finally, the draft will be checked by the secretarial section of the district government office and sent to the leaders of the district government for signature and issuance.

Detailed rules for the implementation of medical security for key entitled groups in Wangcheng District of Changsha City Chapter I General Provisions

Article 1 In order to ensure the medical treatment of key entitled groups, these detailed rules are formulated in accordance with the spirit of the Regulations on Pensions and Preferential Treatment for Servicemen and the Measures for the Medical Protection of Key Entitled Groups (Minfa [2007]10/No.) and combined with the actual situation in our region.

Article 2 In accordance with the principle of territorial management, a medical security system for key entitled groups shall be established, with participation in the basic medical insurance for urban workers and urban and rural residents as the main part, supplemented by medical subsidies and medical assistance for key entitled groups, to ensure that the level of medical security is compatible with the economic development level and financial affordability of the whole region, and to ensure the basic medical needs of key entitled groups.

Article 3 Key entitled groups with dual or multiple identities shall enjoy medical security treatment according to the principle of "giving priority to the elderly".

Chapter II Medical Security Objects

Article 4 The following key entitled groups who have the household registration of urban and rural residents in this district and enjoy regular pensions or regular quantitative living allowances within the administrative area of this district shall enjoy medical security in accordance with these Provisions:

(1) disabled soldiers who retired from active service (hereinafter referred to as disabled soldiers);

(2) Survivors of martyrs, servicemen who died in the line of duty and deceased servicemen (hereinafter referred to as "three genera");

(three) demobilized soldiers in the township;

(four) retired soldiers who return home sick;

(5) Veterans who have participated in wars and nuclear wars.

Chapter III Sources of Medical Security Fund

Fifth key entitled groups of medical insurance funds for:

Financial arrangements at all levels of funds;

(2) Welfare lottery public welfare fund;

(3) Other funds.

Chapter IV Contents, Standards and Procedures of Medical Security

Article 6 The medical treatment of Grade I to VI disabled soldiers shall still be implemented by the District Human Resources and Social Security Bureau according to the existing regulations.

Seventh subsidized insurance.

Participate in the basic medical insurance for urban workers.

1.7- 10 disabled soldiers, if you have a work unit, you will participate in the basic medical insurance for urban workers with your unit, and the payment will be paid by your unit and individual according to the regulations.

2.7- 10 disabled soldiers, whose unit is bankrupt or unemployed after restructuring, will participate in medical insurance for urban workers. After the examination and confirmation by the District Civil Affairs Bureau, the District Finance Bureau and the District Human Resources and Social Security Bureau, the part paid by the unit and the part paid by the individual will be solved from the medical security funds for key entitled groups.

Participate in the basic medical insurance for urban and rural residents.

Urban non-working units and rural seven to ten disabled soldiers, "three genera", rural demobilized soldiers, sick veterans returning to their hometowns, and nuclear personnel participating in the war participated in the basic medical insurance for urban and rural residents in accordance with the regulations, and their individual insurance contributions were determined by the District Civil Affairs Bureau and solved from the medical security funds for key entitled groups.

Eighth outpatient Medicaid

To participate in the basic medical insurance for urban and rural residents, the key entitled groups, outpatient subsidies according to the following different objects to give different standards of fixed subsidies, subsidy standards for:

1. Seven to ten disabled soldiers, "three genera" and rural demobilized soldiers who have no work units subsidize 600 yuan every year;

2 sick veterans, war veterans, nuclear veterans per person per year subsidy 400 yuan.

Handling procedures: the personal outpatient subsidy for the above-mentioned objects is allocated by the District Civil Affairs Bureau through the District Finance Bureau to the personal accounts of key entitled groups, and the civil affairs department will no longer reimburse their personal outpatient medical expenses.

Article 9 Hospitalization Medicaid

For the key entitled groups participating in the basic medical insurance for urban and rural residents, the hospitalization expenses incurred in the designated medical service institutions shall be reimbursed (compensated) within the prescribed cost range, and the self-paid part shall be reimbursed (compensated) according to different objects, and the designated medical service institutions shall reduce or exempt the expenses and other policy subsidies:

1. The subsidy standards for the out-of-pocket part of medical expenses for rural retired soldiers who have no work units and have dual identities of participating in the war and returning home sick are as follows: 60% for the special care medical service institutions designated by the District Civil Affairs Bureau, and 50% for the special care medical service institutions not designated by the District Civil Affairs Bureau. Among them, the subsidy ratio of rural five-guarantee households and urban "three no-personnel" veterans is 100%.

2. The out-of-pocket subsidy standard for medical expenses of retired soldiers who returned home to fight in spite of illness is: 50% for special care medical service institutions designated by the District Civil Affairs Bureau, and 40% for special care medical service institutions not designated by the District Civil Affairs Bureau. Among them, the subsidy ratio of rural five-guarantee households and urban "three noes" veterans is 100%.

The maximum annual medical subsidy for key special care recipients is 1.5 million yuan.

Handler:

1. The hospitalization expenses incurred by the key entitled groups in the designated medical service institutions of the District Civil Affairs Bureau shall be handled by the key entitled groups on the basis of the hospitalization notice, my ID card and the Medical Security Manual for the key entitled groups in Wangcheng District, Changsha City.

The hospitalization expenses incurred by key entitled groups in the designated medical service institutions of the District Civil Affairs Bureau shall be paid in advance by the designated medical service institutions and settled with the District Civil Affairs Bureau on a regular basis. At the time of settlement, provide hospitalization expense payment statement, urban and rural residents' basic medical insurance statement, hospitalization medical expense subsidy statement, hospitalization medical expense subsidy statistics table and other materials. Subsidies and designated medical service institutions shall sign or seal the "Table of Subsidies for Hospitalization Medical Expenses" respectively, and pay them after being audited by the District Civil Affairs Bureau.

2. The key entitled groups participating in the basic medical insurance for urban and rural residents apply for hospitalization subsidy in the designated medical service institutions of the non-district civil affairs bureau, and the key entitled groups apply for hospitalization subsidy to the district civil affairs bureau within three months after discharge with their ID cards, the medical security manual for key entitled groups in Wangcheng District of Changsha City, hospitalization invoices and medical insurance statements. After the approval of the District Civil Affairs Bureau, the hospitalization subsidy will be allocated to the personal accounts of key entitled groups.

Medical expenses beyond the scope of reimbursement (compensation) stipulated in the basic medical insurance for urban and rural residents are not included in the scope of hospitalization Medicaid; The provisions of the basic medical insurance for urban and rural residents "do not belong to the scope of payment of the basic medical insurance fund", and do not enjoy the hospitalization Medicaid as stipulated in these rules.

Tenth seven to ten disabled soldiers old injury recurrence treatment, the unified designated Wangcheng District People's Hospital treatment, has participated in work-related injury insurance, according to the provisions of the work-related injury insurance fund to pay; Did not participate in work-related injury insurance, there is a work unit by the work unit in accordance with the provisions of the solution. Unemployed persons who have no work units and who are unemployed after bankruptcy and restructuring shall be paid in advance by designated hospitals according to regulations, and the designated hospitals and the District Civil Affairs Bureau shall settle accounts regularly. If the object really needs to be transferred for treatment, it can be transferred for treatment and reimbursed for related expenses after being reported to the District Civil Affairs Bureau for approval and filing.

Article 1 1 Special medical assistance

The hospitalization expenses incurred by key entitled groups in the designated medical service institutions shall be reimbursed (compensated) according to the prescribed proportion within the prescribed reimbursement (compensation) expenses, enjoy the fee reduction and exemption of the designated medical service institutions, other policy subsidies and Medicaid of the District Civil Affairs Bureau, and give special medical assistance:

1.5000 yuan to 1 10,000 yuan, with a subsidy of 2,000 yuan;

2. 10000 yuan to 20000 yuan, with a subsidy of 4000 yuan;

3 more than 20000 yuan, 6000 yuan subsidy.

Handling procedures: After handling hospitalization reimbursement (compensation), the subject submits an application to the District Civil Affairs Bureau with his ID card, hospital diagnosis certificate and medical settlement. Special medical assistance key entitled groups enjoy assistance once a year.

Chapter V Payment and Management of Medical Security Fund

Twelfth key entitled groups of medical insurance funds, unified declaration by the District Civil Affairs Bureau at the beginning of the year, included in the district budget.

Thirteenth to six disabled soldiers insurance costs, outpatient subsidies and hospitalization expenses directly allocated by the District Finance Bureau to the District Human Resources and Social Security Bureau medical insurance center. Seven to ten disabled soldiers, "three genera", rural demobilized soldiers, war veterans, nuclear veterans, sick veterans returning home, outpatient subsidies and hospitalization subsidies are uniformly distributed, managed and distributed by the District Civil Affairs Bureau.

Article 14 The District Civil Affairs Bureau shall set up a special account for the payment of medical security funds for key entitled groups, and the medical security funds for key entitled groups shall be managed in special accounts and earmarked for special purposes. Corruption, misappropriation, interception and misappropriation are strictly prohibited. The management and use of medical security funds for key entitled groups shall be subject to the supervision of the District Finance Bureau, the District Audit Bureau, the District Supervision Bureau and other departments.

Chapter VI Organization and Implementation

Fifteenth key entitled groups medical security work led by the District People's government, the relevant functional departments and institutions to implement.

Article 16 District Civil Affairs Bureau is the administrative department in charge of medical security for key entitled groups, responsible for comprehensive coordination of medical security for key entitled groups, drawing up fund plans, establishing medical information files for key entitled groups, and organizing key entitled groups to participate in basic medical insurance for urban workers and basic medical insurance for urban and rural residents. With the District Health and Family Planning Bureau, the District Human Resources and Social Security Bureau * * * to review and determine the designated medical service institutions for medical security of key entitled groups, guide the construction of a "one-stop" settlement platform for designated medical service institutions, and issue the "Handbook of Medical Security for Key Entitled Groups in Wangcheng District of Changsha City" to honor Medicaid.

Seventeenth District Finance Bureau is responsible for arranging the budget and working funds of medical security funds for key entitled groups, and is responsible for the allocation and supervision of medical security funds for key entitled groups.

Article 18 District Human Resources and Social Security Bureau is responsible for including eligible key entitled groups into basic medical insurance for urban workers and basic medical insurance for urban and rural residents, ensuring that the insured key entitled groups enjoy corresponding medical insurance benefits according to regulations, providing relevant information of key entitled groups who have enjoyed medical insurance benefits to District Civil Affairs Bureau, and assisting in the construction and settlement of "one-stop" settlement platform for designated medical service institutions.

Nineteenth District Health and Family Planning Bureau is responsible for the construction and settlement of the "one-stop" settlement platform for medical service institutions, strengthen the supervision and management of designated medical service institutions, standardize medical services, improve service quality and ensure medical safety.

Article 20 Designated medical service institutions shall establish a "one-stop" settlement platform in accordance with the requirements stipulated by the District Civil Affairs Bureau and the District Health and Family Planning Bureau, formulate relevant preferential measures, strengthen the guidance and management of medical treatment and medication for key entitled groups, and ensure that medical treatment and medication for key entitled groups meet the relevant provisions of the national basic medical insurance for urban workers and basic medical insurance for urban and rural residents.

Chapter VII Legal Liability

Article 21 If the unit where the key entitled groups are located fails to pay the basic medical insurance premium for urban workers in accordance with the regulations, the District Human Resources and Social Security Bureau shall order them to fulfill their obligations within a time limit; Fails to perform within the time limit, shall be given administrative punishment in accordance with the provisions of the "Provisional Regulations on the Collection and Payment of Social Insurance Fees" of the State Council. If key entitled groups suffer losses due to non-performance of payment obligations, they shall be liable for compensation according to law.

Article 22 Where the medical security management institutions and their staff members of key entitled groups and the units and their staff members who participate in the medical security work of key entitled groups violate the regulations to examine and approve the medical security benefits of key entitled groups or issue false certificates when examining and approving the medical security benefits of key entitled groups, the competent department at a higher level shall order them to make corrections and give administrative sanctions to the relevant responsible persons. If the circumstances are serious enough to constitute a crime, legal responsibility shall be investigated according to law.

Article 23 where key entitled groups impersonate medical security funds, medical assistance funds or medical subsidies for key entitled groups, the relevant departments shall give them a warning and order them to return their illegal income; If the circumstances are serious, stop enjoying medical security benefits for key entitled groups.

Chapter VIII Supplementary Provisions

Twenty-fourth these rules shall come into force as of June 6, 2005.