Questions and answers on medical insurance for urban workers in Xingtai city: Xingtai residents' medical insurance policy.

1. What is the standard for urban workers to pay medical insurance?

A: The contribution ratio of party and government organs and fully funded institutions is 7.2% of the total wages of employees in the previous year, and the contribution ratio of other employers is 7.8% of the total wages of employees in the previous year; The proportion of individual contributions is 2%. Retired soldiers in accordance with the relevant provisions.

If the payment base of medical insurance for employees is lower than the average salary of employees in full-caliber urban units, the payment base shall be the average salary of employees in full-caliber urban units, and the actual salary shall be the payment base if it is higher than the average salary of employees in full-caliber urban units.

2. What is full caliber salary?

A: The average wage of employees in full-caliber urban units is calculated by weighting the average wage of employees in urban non-private units and the average wage of employees in urban private units. In 2020, the average wage of employees in full-caliber urban units will be 55,754 yuan.

3. How many years do I need to pay?

Answer: When employees who participate in basic medical insurance retire, the minimum payment period is 30 years for men and 25 years for women. Before the basic medical insurance system for employees was officially launched on June 65438+1 October1,the length of service recognized by the state or the payment period of basic old-age insurance was regarded as the payment period of basic medical insurance for employees. However, the number of years that the insured actually pays the basic medical insurance premium shall not be less than 15 years. If payment is interrupted, the payment period before and after the interruption of payment can be accumulated.

4. What should I do before the payment deadline?

Answer: Those who have reached the minimum payment period and not reached the statutory retirement age will continue to pay the basic medical insurance premium and enjoy the basic medical insurance benefits for on-the-job employees; Persons who have reached the minimum payment period and the statutory retirement age can enjoy the basic medical insurance benefits for retirees without paying the basic medical insurance premium from the next month after going through the retirement formalities.

When the insured retires, if the one-time payment base is lower than the average wage of employees in full-caliber urban units, the average wage of employees in full-caliber urban units shall be the payment base; If it is higher than the average wage of employees in full-caliber urban units, it will be based on the current on-the-job payment base. The payment standard is 7% of the one-time payment base.

If the payment period does not reach the prescribed payment period, the unit and individual shall pay it in one lump sum, or they may continue to pay according to the standard of on-the-job employees and enjoy the basic medical insurance benefits for on-the-job employees.

If the normal payment is interrupted for more than 6 months, the personal account of basic medical insurance can be reissued, but the basic medical insurance benefits will not be enjoyed after the deadline.

If it is necessary to pay back the medical insurance premium due to the interruption of payment, in accordance with the provisions of the Social Insurance Law, a late payment fee of 0.5% will be charged on a daily basis from the date of default, which will be approved by the medical insurance department and collected by the tax department.

5. Can residents' medical insurance years be converted into employees?

Answer: Insured persons who have changed from the basic medical insurance for urban and rural residents to the basic medical insurance for employees, who have participated in the basic medical insurance for urban and rural residents for four years in this city, can be converted into the payment period of the basic medical insurance for employees of 1 year.

6. How to handle the transfer and connection procedures?

Answer: 1. Transfer of basic medical insurance as a whole: the insured person handles it himself: the original social security card or ID card and a copy of the bank card; Agency handling: the original and copy of the social security card or ID card of the insured, the copy of the bank card, and the original and copy of the ID card of the agent.

2. The basic medical insurance is transferred to the overall planning: the insured person himself handles: application form, ID card or social security card, insurance certificate and information form; Agent handling: application form, original and photocopy of the insured's ID card, original social security card and agent's ID card, insurance certificate and information form.

7. How to pay for my personal account?

Answer: 1. Refund the basic medical insurance premium of the deceased and personal account.

Original and photocopy of agent's ID card, original and photocopy of insured's ID card, photocopy of bank card and photocopy of cremation certificate;

2, inter provincial resettlement personnel basic medical insurance personal account declaration form

The insured himself: the original social security card and a copy of the bank card; Agency handling: the original and photocopy of the insured's social security card and the original and photocopy of the agent's ID card.

8. Can flexible employees enjoy treatment immediately after joining the insurance?

A: Flexible employees can enjoy basic medical insurance benefits only after paying the basic medical insurance premium for three months in a row.

9. What is the payment standard for flexible employees?

A: From June 5438+1 October1day in 2022, flexible employees will pay the basic medical insurance at 9% of the average salary of employees in full-scale urban units in the previous year, and will not pay maternity insurance. Establish a personal account of basic medical insurance and enjoy the overall treatment of outpatient service.

10. How to record cross-provincial medical treatment?

A: Procedures that the agency needs to file: ID card or social security card.

Self-filing: by paying attention to the official WeChat account of Xingtai Medical Security Bureau-click on business processing-Hebei Smart Medical Insurance-medical treatment in different places for filing, and follow the prompts for filing.

1 1. What is the basic medical insurance for employees?

Answer: The hospitalization Qifubiaozhun of the employee basic medical insurance pooling fund is implemented according to the following provisions: 200 yuan, a first-level hospital, 300 yuan, a second-level hospital, and 600 yuan, a third-level hospital; If the insured is hospitalized for many times in a natural year, the first two hospitalizations shall be subject to Qifubiaozhun, and the hospitalization for more than three times shall not be subject to Qifubiaozhun; But many times in the community health service center hospitalization, according to Qifubiaozhun.

On-the-job employees are hospitalized in designated medical institutions at the first, second and third levels, and the reimbursement rates within the policy range are 96%, 93% and 88% respectively. Increase the reimbursement rate of medical insurance retirees 1 percentage point. In a natural year, 95% of the medical expenses incurred by urban workers in compliance with the regulations that exceed10.2 million yuan to 500,000 yuan shall be paid by large medical insurance.

12. What benefits does maternity insurance enjoy?

A: Maternity allowance.

The wages of female employees in public institutions during maternity leave and birth control leave are paid by the employer according to the wages before maternity leave, and they do not enjoy maternity allowance; Flexible employees do not enjoy maternity allowance.

If other employers pay the fees in full and on time, and the female employees give birth according to law, the insured will pay the fees continuously for 12 months or more, and the female employees will enjoy the maternity allowance after giving birth.

Maternity medical expenses.

Those who have paid for 3 months or more before delivery can enjoy maternity medical expenses. Unemployed spouses and flexible employees of insured male employees enjoy maternity medical expenses at 50%, and the unemployed spouses of male employees shall not repeatedly enjoy the maternity subsidy stipulated by the medical insurance for urban and rural residents.

13. What is the subsidy standard for maternity medical expenses?

A: The natural childbirth allowance is 3,000 yuan, the artificial childbirth allowance is 3,500 yuan, the cesarean section allowance is 4,000 yuan, and the cesarean section plus other operations allowance is 4,500 yuan. For multiple births, the corresponding allowance is increased by 50%.

14. How to declare maternity allowance?

Answer: Within 150 days after giving birth or within 60 days after birth control measures are implemented, the employer shall fill out the Application Form for Maternity Allowance for Urban Workers in Xingtai City and report to the medical insurance agency in the insured area with the following materials: 1. Copy of my social security card; 2. Comply with the birth-related materials or birth QR code information in the policy; 3. The original and photocopy of the medical certificate of the baby's birth, and relevant information provided by those who are not alive; 4. Discharge record.

15. What is the treatment standard of family planning medical expenses?

A: All eligible family planning medical expenses are subject to a fixed subsidy, and those below the fixed subsidy standard are paid according to actual expenses. The subsidy standard is: termination of pregnancy less than 2 months 150 yuan; 300 yuan who terminated her pregnancy after 2 months and less than 4 months; 800 yuan who terminated her pregnancy after 4 months but less than 6 months; If the pregnancy is terminated for 6 months or more, it shall be paid according to the hospitalization maternity medical expenses; Check pregnancy and environmental conditions in 70 yuan; Placement of intrauterine contraceptive ring and various hospital examinations specified by technical routine 150 yuan; Take out the intrauterine contraceptive ring 50 yuan; Tubal ligation 2000 yuan; 300 yuan, who did vasectomy?

16. when is the deadline for granting maternity allowance?

A: The payment period of maternity allowance for eligible insured employees is: 98 days of maternity leave, and couples who have children in accordance with laws and regulations extend maternity leave for 60 days; Increased maternity leave for dystocia 15 days; In case of multiple births, the maternity leave will be increased by 1 5 days for each additional child; Female employees who miscarry less than 4 months after pregnancy are entitled to 15 days maternity leave; Abortion after 4 months of pregnancy is entitled to 42 days of maternity leave. If the birth of a female worker meets the conditions of dystocia and multiple births at the same time, the added maternity leave days shall be calculated cumulatively.

Insured workers who place or take out intrauterine devices shall rest for 2 days from the date of operation; Place or take out the subcutaneous implant and rest for 3 days; Vasectomy, rest for 7 days; Tubal ligation, rest 2 1 day. The following holidays are added to the insured female employees who have undergone pregnancy termination surgery and taken the following birth control measures: 2 days off for those who have placed intrauterine devices; The rest time for tubal ligation is 10 day.

17. What is the standard of maternity allowance?

Answer: Based on the actual average monthly payment base of the insured employees in the previous year, divide it by 30 and multiply it by the number of maternity leave days.

18. What should I do if I have multiple births?

Answer: For enterprises that pay maternity insurance premiums in full and on time, the maternity allowance for female employees who have given birth to their first and second children according to law shall be paid in 20 16 years 158 days when giving birth to their second child. According to the latest family planning regulations of 202 1 Hebei province, the payment period of maternity allowance for the third child is extended by 30 days on the basis of the original policy. Treatment of abortion, dystocia, multiple births and family planning leave. Still subject to the current policies and regulations in the overall planning area.

19. How to declare chronic diseases and special diseases in outpatient department?

A: Log in to the personal online hall or WeChat applet of Hebei Medical Insurance Company. Alternatively, you can pay attention to the official WeChat account of Xingtai Medical Insurance Bureau, click on the business in the lower left corner, select Hebei Smart Medical Insurance-Chronic Disease Declaration, and register online. Fill in the basic information of the applicant and declare the diseases, and upload the original medical records or outpatient medical records and related inspection and laboratory data that can support the declaration of diseases in the past year; Independent selection of designated medical institutions with accreditation qualifications; Fill in the complete submission.

20. What is the treatment for chronic diseases in outpatient department?

A: The threshold for reimbursement of chronic special diseases in outpatient department is 400 yuan per person per year, and the threshold for applying for reimbursement of special diseases in outpatient department for more than two times is not accumulated.

There is no small catalogue of major diseases in outpatient department. Medical expenses that meet the requirements of basic medical insurance and exceed Qifubiaozhun shall be paid in advance according to the requirements of the national drug list, and 85% shall be paid by the overall fund.

Outpatient chronic diseases shall be managed by quota, and medical expenses that meet the requirements of basic medical insurance shall be paid in advance according to the requirements of the national drug list after exceeding the Qifubiaozhun, and 70% shall be paid by the overall fund.

2 1. What is the declaration process for special drugs?

Answer: Insured employees must hold social security cards and related materials to the medical insurance department of designated medical institutions for special drugs to receive the Application Form and Evaluation Form for the Use of Special Drugs in Xingtai City Medical Insurance for Urban Employees, which will be evaluated and confirmed by the doctors responsible for special drugs, and completed after being approved by the medical insurance department of medical institutions.

22. How to buy specific drugs?

A: The insured employees who have been registered need to use special drugs. First, the doctor in charge of special drugs will issue a paper prescription. After the signature of the doctor in charge of special drugs, the paper prescription shall be examined and confirmed by the medical insurance department of the medical institution where it is located, stamped with the special seal for special drugs, and purchased by swiping the card at the designated pharmacy for special drugs.

23. What is the payment standard for special drugs?

Answer: There is no deductible for the special drug expenses incurred by the insured employees in the special drug pharmacy. The payment standard is implemented with reference to the special disease policy for urban workers in Xingtai City.

After the special drugs are paid by the overall medical insurance fund, the personal burden can be paid from the balance of the personal account fund, and the personal account is insufficient or has not been established by the personal cash.

24. How many kinds of special drugs are there?

A: At present, there are 66 drugs.

24. Which hospitals or pharmacies can buy specific drugs?

A: Xingtai People's Hospital, Xingtai First Hospital, Rongmin Hospital, Third Hospital and Second Affiliated Hospital of Medical College.

Lerentang Zhongxing Street Store, Minsheng Hongxing Street Store and Tianyu Du Xiang North Road Store.

25. How to transfer personal accounts?

A: Since June 5438+1 October1day, 2022, according to the contents of the Notice of Xingtai Municipal People's Government Office on Implementing Rules for Establishing and Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients, the personal accounts of employees in our city have been included in the proportion and measures.

Personal accounts of employees are included in the standard of 2% of the base of my insurance payment; Individual accounts of retirees are allocated by the overall fund according to the quota, the party and government organs and full-time institutions allocate 78 yuan, and other employers allocate 5 1 yuan. Those who work until retirement will be included in the personal account standard from the month after their change.

26. What is the outpatient meter policy? What is the standard of treatment?

A: It means that the general outpatient expenses of frequently-occurring diseases and common diseases are included in the payment scope of the overall fund. Implementation of the basic medical insurance drug list, diagnosis and treatment project list, medical service facilities and payment standards. In a natural year, set the minimum payment standard and the maximum payment limit.

Qifubiaozhun is 100 yuan per person per year. Maximum payment limit within the scope of the overall fund policy, employee 800 yuan, retiree 1 000 yuan. Above Qifubiaozhun, below the maximum payment limit of the overall fund, the proportion of the overall fund payment is 50% for employees and 60% for retirees. Insured persons use pure Chinese medicine treatment spells in designated medical institutions to pay the general outpatient medical expenses within the scope, and the payment ratio is increased by 20 percentage points.

27. What is the difference between intra-provincial and inter-provincial outpatient treatment? Can I pay for non-designated medical care in the city?

A: When making overall plans for medical treatment in other places in the province, the policy of equal treatment of medical institutions at the same level shall be implemented.

For cross-provincial medical treatment in different places, the proportion of compliant medical expenses for outpatient treatment decreased by 10 percentage point on the original basis.

Due to sudden illness, the insured went to other medical institutions in our city except the designated medical institutions for general outpatient service, and did not go through the hospitalization procedures. The emergency medical expenses incurred shall be paid in proportion to the local outpatient service.

28. What are the policies of 30 hospitals in Beijing and Tianjin?

Answer: After medical treatment in different places is filed, it will be settled according to the medical insurance catalogue of the place where medical treatment is sought and the hospitalization reimbursement ratio of designated medical institutions of the same level and category in Xingtai City. These 30 medical institutions include:

Beijing 15: Peking Union Medical College Hospital of China Academy of Medical Sciences, General Hospital of Chinese People's Liberation Army, First Hospital of Peking University, People's Hospital of Peking University, Third Hospital of Peking University, China-Japan Friendship Hospital, Fuwai Hospital of China Academy of Medical Sciences, anzhen hospital and beijing jishuitan hospital affiliated to Capital Medical University, Cancer Hospital of China Academy of Medical Sciences, Beijing Cancer Hospital, Beijing Tongren Hospital affiliated to Capital Medical University, Beijing Children's Hospital affiliated to Capital Medical University, and Seventh Medical Center of China People's General Hospital.

Tianjin 15: General Hospital of Tianjin Medical University, Tianjin People's Hospital, Tianjin First Central Hospital, Tianjin Third Central Hospital, First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin TEDA International Cardiovascular Hospital, Tianjin Cancer Hospital, Hematology Hospital of China Medical Academy, tianjin huanhu hospital, Tianjin Chest Hospital, Tianjin Children's Hospital, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin Eye Hospital, Tianjin Medical University Stomatological Hospital, etc.

29. Overview of the policy of non-discrimination in the province

A: Xingtai City started its work in the whole province from September 2002 1 day to September1day. The population covered is urban workers and urban and rural residents in all the overall planning areas in the province, and the implementation scope is medical expenses within the scope of policies such as hospitalization, outpatient medical treatment and drug purchase in medical institutions that have opened hospitalization or outpatient medical insurance in the province. What concerns the interests of ordinary people is the change of filing and treatment.

The first is archiving. Cancellation of medical record in different places in the province means that the insured can choose the designated medical institutions and retail pharmacies that have opened direct settlement of hospitalization and outpatient expenses in different places in all co-ordination areas in the province without filing, so as to realize direct settlement of medical treatment in different places in the province.

The second is treatment. First, hospitalization, when hospitalized in other co-ordination areas in the province, the deductible line will no longer be improved, the reimbursement ratio will be reduced, and the equal treatment policy of medical institutions at the same level will be realized; Second, the general outpatient clinics in the province can be directly settled in different places, and the designated medical institutions above the second level in the province can be directly settled with personal accounts; Third, outpatient chronic disease settlement is more convenient. Chronic diseases in outpatient clinics in different places in the province can be directly settled, and the number of chronic diseases in designated outpatient clinics in all co-ordination areas can be cancelled. Limit the designated medical institutions above the second level in the province to use basic medical insurance and personal accounts for direct settlement; Fourth, it is more convenient to buy medicine. The direct settlement of employee medical insurance personal accounts in different places in the province is subject to the scope of application stipulated by the state and can be used in designated retail pharmacies in the province.