When will Luoyang medical insurance be paid in 2023?
In 2023, the payment of basic medical insurance for urban and rural residents in Luoyang has started, and the specific time is from September 26, 2022 to February 30, 2022, 65438+3 1. The basic medical insurance for urban and rural residents is a basic medical security system organized by the government, covering all urban and rural residents, and combining individual contributions with government subsidies, focusing on ensuring the general outpatient medical care, special disease outpatient medical care, serious and serious disease medical care and hospitalization medical care (including reproductive medical care and neonatal medical care) of the insured residents. In order to ensure medical reimbursement for you and your family, please actively pay medical insurance premiums for urban and rural residents on time; At the same time, in order to facilitate urban and rural residents to pay fees and understand their own rights and interests, the author visited the relevant person in charge of the Municipal Medical Security Center on September 28. The details are as follows.
I. Scope of the Insured
The urban and rural residents of medical insurance coverage who are not included in the administrative area of Luoyang. Include the following personnel:
1. Rural residents;
2. Non-employed urban residents;
3. Residents holding residence permits in this Municipality;
4. Full-time undergraduate students, full-time graduate students and students from vocational high schools, technical secondary schools and technical schools who receive general higher education in various full-time colleges and research institutes;
5 other personnel stipulated by the state and our province.
Second, the insurance payment standard
In 2023, the individual payment standard of basic medical insurance for urban and rural residents (including full-time college students) will be 350 yuan/person. The serious illness insurance fund for urban and rural residents is allocated from the basic medical insurance fund, and the insured residents do not pay. In 2023, the per capita financial subsidy standard will be moderately increased on the basis of June 202210 yuan.
Three, the insured payment period and treatment time.
Payment period of basic medical insurance for urban and rural residents in 2023: 26 September 2022-65438 June 2022+3 February1; Time to enjoy the basic medical insurance for urban and rural residents in 2023: 2023 10/-2023/2 1.
Fourth, the insurance payment method
(1) payment method: centralized collection and decentralized payment are adopted.
1. Centralized payment: during the centralized payment period, urban and rural residents apply for payment in the village (community) where their household registration is located, and the specific matters shall be subject to the notice of the local government;
2. Decentralized payment: payment can be made through bank outlets such as Zhongyuan Bank and China Bank, the self-service terminal of the Tax Service Office of the Tax Bureau, the micro-program "Henan Tax" on the WeChat official account or the micro-program "Henan Tax" on Alipay.
(2) Handling procedures:
1. Urban and rural residents apply for payment in the village (community) where their household registration is located.
2. The renewal personnel who pay the scattered fees can pay through WeChat and other channels, or bring the original household registration book (resident ID card) to the nearest bank outlets such as Zhongyuan Bank and China Bank. When paying the fee; the information for the insured must be verified through the self-service payment interface or toll collectors; and then the payment is made after verification. If you can't find personal information or the information of the insured place is wrong, please go to the county (district) medical insurance center or office (township) or community (village) where you are registered or live, verify the relevant information and re-register in the new insured place, and pay the fee in the above way.
3. For the first time, if the insured pays the scattered expenses, they must bring the original and photocopy of the household registration book or resident identity card (residence permit) to the office (township) and community (village) where the household registration is located. After registration, the insured person can pay through the above channels such as WeChat, or go to the nearest tax hall to check the payment. Please verify the information of the insured place before confirming the payment.
4 full-time college students are responsible for the collective collection of insurance premiums by the school.
Verb (abbreviation for verb) Medical insurance benefits patients.
(1) hospitalization
The hospitalization expenses of insured residents within the policy scope of designated medical institutions shall be paid by individuals below the Qifubiaozhun; Qifubiaozhun above is paid by the overall fund in proportion, and the annual maximum payment limit of the basic medical insurance fund for urban and rural residents is 6,543,800 yuan+0.5 million yuan.
Qifubiaozhun and reimbursement ratio of insured residents in hospital
14 years old (including 14 years old), the minimum qifubiaozhun for insured residents will be halved, and the minimum qifubiaozhun for other insured residents will be halved in hospitals above the county level for the second time that year; If you are hospitalized for the same disease for the second time within 30 days, you will only pay the Qifubiaozhun once. The second hospitalization, the hospital level is higher than the first hospital level, only pay the difference between Qifubiaozhun; If the insured residents in Luoyang are hospitalized in Chinese medicine hospitals at or above the county level, the Qifubiaozhun for hospitalization reimbursement will be reduced by 100 yuan on the basis of the standards stipulated by medical institutions at the same level. The proportion of reimbursement of hospitalization medical expenses for insured residents using Chinese medicine services increased by 5%. Chinese medicine service projects refer to Chinese herbal pieces, Chinese patent medicines, Chinese medicine preparations and Chinese medicine diagnosis and treatment projects included in the scope of reimbursement of basic medical insurance.
(2) General outpatient medical treatment
The medical expenses incurred by the insured residents in the outpatient service of designated medical institutions at the grass-roots level within the policy scope shall be reimbursed according to the proportion of 50%, and the annual reimbursement limit shall be 260 yuan/person. The original personal (family) account balance is not clear, but it can be used in primary medical institutions such as township hospitals (community health service centers) or village clinics (community health service stations).
Insured residents who are diagnosed with hypertension and diabetes by designated medical institutions and need medication but do not meet the guarantee standards of Luoyang special disease outpatient service and Henan serious and serious disease outpatient service can be included in the scope of outpatient co-ordination reimbursement, and the drug expenses within the policy scope are reimbursed at 50%, with the highest annual reimbursement limit of 240 yuan/person.
(3) Outpatient medical treatment of chronic diseases and special diseases
Luoyang city will include some diseases (or treatment items) that need long-term or lifelong outpatient treatment and have high medical expenses into the scope of medical treatment for special diseases. There is no Qifubiaozhun for special disease clinics, and the reimbursement rate within the policy scope is 80%, and fixed-point treatment and quota management are implemented. There are currently 38 diseases.
Insured residents can enjoy outpatient medical treatment for special diseases according to regulations after being identified. According to different diseases, the identification of special disease clinics adopts two ways: centralized identification and non-centralized identification. The centralized identification of special disease clinics is organized by medical insurance agencies and determined by designated medical institutions on schedule. Non-centralized identification of patients, in the designated hospital at any time to apply for identification cards at any time.
(4) Medical treatment of major diseases
Urban and rural residents suffering from the following 38 kinds of serious diseases can enjoy the medical security treatment for serious diseases of urban and rural residents in our province according to the regulations, that is, they are hospitalized in designated medical institutions and reimbursed at a limited price without deductible; Among them, the reimbursement rates of medical expenses within the hospitalization policy of county-level medical institutions, municipal medical institutions and provincial medical institutions are 80%, 70% and 65% respectively. The specific diseases are as follows-
1. Hospitalization insurance disease
2. Outpatient insurance diseases shall be subject to the policy adjustment of Henan Province. For details, please consult the Medical Insurance Service Section of urban and rural residents and the medical insurance offices of major hospitals, relevant security policies, identification procedures, medical treatment settlement methods, etc. There is also an inquiry about the official account of WeChat WeChat "Luoyang Medical Insurance".
(5) Reproductive health care
Pregnant women who participate in medical insurance for urban and rural residents give birth in hospital, and the hospitalization medical expenses are limited to pay. The limit standards are: 600 yuan for natural delivery, 800 yuan for dystocia, cesarean section 1600 yuan.
(6) preferential treatment for newborn insurance.
In the year when the newborn was born, the parents who participated in the basic medical insurance (including the troops stationed in Luo) automatically obtained the insurance qualification and enjoyed the medical insurance benefits for urban and rural residents. Newborn mothers or fathers who participate in the medical insurance for urban and rural residents in our city can enjoy the medical insurance benefits for urban and rural residents in the year of birth with their mother's or father's identity certificate and birth medical certificate. Parents did not participate in the medical insurance for urban and rural residents in our city, according to the provisions of the medical insurance agencies for insurance procedures.
Six, serious illness medical insurance
Luoyang city serious illness insurance funds allocated from the basic medical insurance fund for urban and rural residents, insured residents no longer pay. According to the unified standards of the whole province, the part of the medical expenses that the insured residents personally bear within the policy scope exceeds 1. 1 000 yuan shall be reimbursed according to the following proportion: 1. 1 000 yuan ~ 1 000 yuan (including 1. 65,438+70% for the part above 10,000 yuan; You can reimburse up to 400,000 a year.
During the connection between poverty alleviation and rural revitalization, preferential policies for serious illness insurance will be implemented for low-income people, poor people and people returning to poverty. The deductible was reduced from 1. 1.000 yuan to 0.55 million yuan, and the reimbursement rate was increased by 5 percentage points. There is no capping line for reimbursement of serious illness insurance during the year.
Seven, insured residents can apply for medical treatment.
And seek medical treatment in different places
Insured residents who need to be referred to the insured city for medical treatment shall go through the procedures of referral and transfer, and enjoy medical insurance benefits according to regulations; In addition to emergency and mental illness, if the referral and transfer procedures are not handled according to the regulations, the reimbursement ratio of the corresponding medical institutions will be reduced by 20 percentage points. The management of referral and referral in our city is implemented in accordance with the Notice of the Henan Provincial Department of Human Resources and Social Security on printing and distributing the Interim Measures for the management of referral and referral of basic medical insurance in Henan Province and medical treatment in different places. Long-term residents in different places can go through the medical record formalities in the local medical insurance agency and enjoy the direct settlement service of medical expenses at their place of residence.
legal ground
Detailed Rules for the Implementation of the Basic Medical Insurance for Urban Residents in Luoyang City
Article 4
The "family-based overall insurance" stipulated in the Measures means that all family members who should participate in the basic medical insurance for urban residents participate in overall insurance on a voluntary basis.
Article 5
The registration of the insured shall be carried out by the community neighborhood committee (hereinafter referred to as the community) by means of household survey and information collection. During the household survey, residents should fill in and provide the following information:
(1) Registration Form for Luoyang Urban Residents to Participate in Basic Medical Insurance;
(2) The original household registration book of family members and a copy of the household registration book, and residents with collective accounts hold a copy of the collective account;
(3) One-inch recent bareheaded photo (not provided for preschool children);
(4) Old people over 60 years old from low-income families should provide proof materials issued by the community and recognized by the office;
(5) Other information provided as required.