June 5438+1October 65438+1October 2020 New Medical Insurance Regulations

Nantong Medical Security Bureau issued a notice

From 1, 2020.

Adjust and unify the relevant provisions of the city's medical insurance

↓↓↓

First, employee medical insurance.

1. raise large medical assistance funds in a unified way. Large medical assistance funds for employees are paid by those who participate in the basic medical insurance for employees. According to the payment standard of each insured person per month 10 yuan.

The payment of the large medical assistance fund shall be withheld and remitted from the salary by the employee's unit while paying the basic medical insurance premium; Retirees are withheld and remitted by the retirement pension issuing unit; Flexible employees are collected and remitted by social security agencies.

2 unified the city's employee medical insurance personal account funds included in the proportion, specifically:

(1) The working personnel are divided into different age groups and determined according to a certain proportion of their annual contribution base: those under 35 years of age (inclusive) are counted as full 1 above and those over 45 years of age (inclusive), and retirees are counted as 5% of their total retirement pension in the previous year.

If the funds transferred into the personal medical account of retirees are lower than the following minimum standards, they will be transferred according to the following standards: 600 yuan under 70 years old, 800 yuan over 70 years old to 80 years old, and over 80 years old 1000 yuan. Before the founding of the People's Republic of China, the number of old workers who participated in revolutionary work still increased by 200 yuan every year.

Persons who retired before 20 19 12 3 1 in Rudong county are still included in the personal account funds according to the original standards.

3. The insured person shall continue to be insured until retirement, and if it is interrupted for some reason, the medical insurance premium during the interruption period may be paid according to the supplementary base of medical insurance in this Municipality published in the current period.

4. Flexible employees who are insured or renewed for the first time will enjoy social medical treatment as a whole from the second month after handling the insurance payment procedures. Medical expenses incurred during the interruption of payment shall not be settled.

5 unified the city's serious illness insurance financing standards, monthly from the annual overall fund per person 16 yuan to raise. Gradually implement the unified bidding by the municipal medical insurance department and entrust the third party to handle the service.

6. Unify the financing standard of self-funded supplementary insurance for hospitalization in the whole city, and raise it by 120 yuan per person per year. Among them, at the beginning of each year, 60 yuan is deducted from the personal medical account funds at one time, and 60 yuan is allocated from the overall fund every year. Self-funded supplementary insurance is gradually implemented by the municipal medical insurance department, and the third party is entrusted to handle the service.

Second, residents' medical insurance

7. If a newborn baby goes through the insurance formalities within the specified time, it shall pay the residents' medical insurance premium from the month of birth to the end of that year, and enjoy the medical insurance benefits from the date of birth.

8. Residents who meet the insurance conditions, fail to participate in the insurance in time or interrupt the insurance after the insurance, will enjoy medical insurance benefits from the second month after handling the insurance payment procedures.

9. Residents who apply to be transferred to employee medical insurance, residents of legal working age in this city (excluding students and minors under 16), and elderly residents who enjoy employee retirement pension beyond legal working age can be converted into employee medical insurance payment period according to the standard of 4: 1. The legal working age to participate in residents' medical insurance payment period is converted into employees' medical insurance payment period of not more than 5 years.

10. Unified outpatient co-ordination standard. The annual accumulative expense limit standard of general outpatient service of basic medical insurance for residents in the whole city is unified as 800 yuan, and the daily expense limit of county (city) is cancelled at the same time.

1 1. Unify the funding standard of serious illness insurance for residents in the whole city and raise it to 1 10 yuan per person per year. Gradually implement the unified bidding by the municipal medical insurance department and entrust the third party to handle the service.

12. unify the payment standard for hospitalization in the whole city. The proportion of residents' hospitalization medical expenses paid by residents' medical insurance fund in each cost segment is above the minimum deductible line of insured hospitalization medical expenses, and the proportion of 0 yuan to 654.38 million yuan (inclusive) is 88%, 83% and 81%in the first, second and third-level designated medical institutions respectively; 654.38+10,000 yuan to 200,000 yuan (inclusive), and the proportion of funds paid by the first, second and third-level designated medical institutions is 93%, 88% and 86% respectively (98%, 96% and 94% for students and minors respectively).

If the insured residents in the city are transferred to the first-class designated medical institutions for hospitalization in the township hospitals (community health service centers) to which family doctors are contracted, or the township hospitals and superior hospitals in the medical association who are contracted to enjoy the overall treatment of outpatient service, the payment ratio of residents' medical insurance fund in each fee segment is adjusted to: 0 yuan to 6,543,800 yuan (inclusive), and the fund pays 90%; 65438+ 10,000 yuan to 200,000 yuan (inclusive), 93% of adult residents (elderly residents) and 98% of students and minors.

13. The insured residents who meet the requirements of maternity insurance will be subsidized by 50% for the expenses of pregnancy and outpatient abortion, and the actual subsidy amount will not exceed that of 400 yuan.

During the hospitalization of insured residents, the basic medical expenses for maternity that meet the requirements of residents' maternity insurance shall be paid by the residents' medical insurance fund according to the disease limit, and if it is lower than the limit standard, it shall be paid according to the actual situation. The specific limit standard is: vaginal delivery 1900 yuan; Vaginal delivery dystocia 2000 yuan; Cesarean section that meets the indications of cesarean section is 2400 yuan, and other cesarean sections are 2200 yuan; Induced abortion 1200 yuan. In case of birth complications during hospital delivery and cesarean section accompanied by hysteromyoma and appendectomy, the subsidy shall not exceed 800 yuan.

Agencies and designated medical institutions shall settle accounts in accordance with the corresponding standards of maternity protection for residents.

Third, others.

14. The city unified the drug list of medical service facilities, the list of diagnosis and treatment items and the payment regulations, and strictly implemented the medical insurance list, the medical insurance payment level and payment regulations, including the general medical expenses of primary medical institutions and the first payment policy for Class B individuals.

15. After the implementation of maternity insurance and basic medical insurance for employees, the two insurances will be registered and paid simultaneously.

Flexible employment, unemployment insurance and payment of employee medical insurance personnel have entered the one-time payment units such as Xiebao (support) to participate in the basic medical insurance for employees, and still pay according to the original employee medical insurance rate, and enjoy the relevant maternity medical expenses according to the original provisions.

16. Cancel the number regulation that the original urban insured persons sign up for general outpatient service and choose designated community health service institutions nearby.

17. The settlement of medical expenses of medical insurance in the whole city shall be implemented in accordance with the relevant provisions of the Measures for the Administration of Medical Insurance Settlement in Nantong City.

18. This notice shall be implemented as of 2020 1.