Strongly protest. Wujin is a district of Changzhou, and everything is different from the other four districts. Those people might as well go home and sell sweet potatoes.
In order to actively promote the reform of the basic medical insurance system for enterprise employees, according to the spirit of document No.87 [2000] of Wu Fa, the implementation measures for the basic medical insurance system for urban employees in Wujin City, and combined with the actual situation of enterprises in our city, this implementation opinion is formulated.
I. Scope and objectives of implementation
All employers who participate in the basic old-age insurance for enterprises include state-owned enterprises, collective enterprises, joint-stock cooperative enterprises, joint-stock enterprises (limited liability companies and joint-stock companies), private enterprises and all on-the-job and retired (post) personnel who have formed labor relations with them (excluding those who did not enjoy free medical care in the 1950s and 1960s, those assigned by township enterprises, and college students and educated youth who were decentralized in the early 1960s).
Personnel belonging to labor and personnel institutions.
All employees and retirees who are stationed in Wujin, provincial employers, military units stationed in Changzhou, foreign institutions stationed in Wujin and form labor relations with them.
Second, outpatient medical expenses
The outpatient medical expenses of enterprise employees shall be issued to individuals by enterprises according to the following standards:
Employees under the age of 36 shall pay 0.9% of the average wage of employees in the previous year.
Workers aged 36 to 46 shall be paid according to 65438+ 0.4% of the average salary of employees in the previous year.
Workers aged 46 to retirement age are paid at 2.2% of the average salary of employees in the previous year.
Retired (post) personnel shall pay 5% of their total pension in the previous year. Under the age of 70, if the monthly payment is lower than that of 30 yuan, it will be paid in 30 yuan; Over 70 years of age, the monthly payment is lower than that of 35 yuan, and it will be paid in 35 yuan.
Retired old workers who took part in revolutionary work before the founding of the People's Republic of China were paid at 6% of their total pension in the previous year. If the monthly payment was less than 100 yuan, it was paid at 100 yuan.
Outpatient special examination and treatment can be carried out according to the Interim Provisions on the Administration of Basic Medical Insurance for Urban Workers in Wujin City, and whether the medical expenses for outpatient specific diseases are subsidized or not is decided by the insured unit. The required expenses shall be paid in the employee welfare funds, and enterprises with insufficient welfare funds may be paid before tax with the approval of the competent tax authorities.
Collection of outpatient medical expenses for enterprise retirees (after-service personnel): the restructured enterprises first collect them from the stripped medical expenses; After the medical expenses are divested, the asset management company in charge of the industry will pay in the asset income; If it is really difficult for an asset management company to pay, it shall be solved by the municipal finance. The poor enterprises confirmed by the municipal government shall be solved by the municipal finance. Enterprises that have not been restructured shall be charged in the employee welfare fund.
Conditional employers can establish a supplementary medical insurance system in accordance with the Interim Measures for Supplementary Medical Insurance for Urban Workers in Wujin City.
The payment method of outpatient medical expenses of the Ministry and provincial employers in Wujin can be implemented with reference to the above standards, and the funds will be solved by themselves.
Third, hospitalization medical expenses
Hospitalization medical expenses shall be co-ordinated throughout the city.
(A) funding standards
Insured units pay the basic hospitalization medical expenses according to the number of employees in the unit, and the standard is 40 yuan per person per month; On-the-job and retired (post) personnel are required to pay the medical assistance fund, and the standard is 5 yuan per person per month.
(2) Sources of funds and channels of expenditure
1, basic hospitalization expenses
The basic hospitalization expenses of all insured enterprises are paid by the unit. Non-retirees affiliated with labor and personnel institutions shall be paid by themselves and collected by affiliated labor and personnel institutions.
2. Medical assistance funds
On-the-job personnel shall be withheld and remitted by the employer; Retired (post) personnel shall be collected by Wujin social labor insurance department; Non-retirees affiliated with labor and personnel agencies shall be collected by labor and personnel agencies.
3, the basic hospitalization medical expenses paid from employee welfare funds, welfare funds insufficient enterprises, approved by the competent tax authorities, can be paid before tax.
(three) the use of funds and settlement methods
The insured must hold personal IC card and "Medical Records of Basic Medical Insurance for Urban Workers in Wujin City" and be hospitalized in designated medical institutions within the scope of this Municipality.
Settlement method: minimum payment standard, maximum payment limit, subsection calculation and cumulative payment shall be implemented. In a settlement year, the hospitalization Qifubiaozhun is three times, namely, the first time in 600 yuan, the second time in 400 yuan and the third time in 200 yuan. Town-level hospitals visited 500 yuan for the first time, 300 yuan for the second time, and 100 yuan for the third time. The maximum payment limit is 4 times of the average wage of employees in our city last year. In case of repeated hospitalization within a settlement year (1 year from July to June 30th of the following year), the medical expenses shall not exceed the maximum payment limit after consolidated calculation. The medical expenses from Qifubiaozhun to the highest payment limit are mainly paid by the basic hospitalization medical co-ordination fee, and individuals also have to bear a certain proportion. The standard is: individual contribution 10000 yuan (inclusive), with a ratio of15%; 10000 yuan to 25000 yuan (inclusive), the individual pays10%; The proportion of individuals paying 25,000 yuan to the maximum payment limit is 5%. Retired (post) personnel shall pay 60% of the above-mentioned self-payment ratio; Retired old workers who participated in revolutionary work before the founding of the People's Republic of China shall pay 50% of the above-mentioned self-payment ratio. The insured person directly pays with the designated medical institutions, and the basic hospitalization medical co-ordination fee is paid by the designated medical institutions and the municipal medical insurance center. Designated medical institutions must record the amount on the personal IC card.
If it is necessary to transfer to a hospital outside the city for medical treatment due to illness, the director of the treatment department shall apply for transfer from Wujin People's Hospital, Wujin Second People's Hospital, Wujin Traditional Chinese Medicine Hospital and Wujin Third People's Hospital. With the consent of the dean in charge, the municipal medical insurance center can transfer the hospital after confirmation, and the expenses will be settled directly in the municipal medical insurance center after transfer. For medical expenses with Qifubiaozhun to the highest payment limit, the proportion of individual self-payment is increased by 10% on the basis of the original proportion of individual self-payment in hospital.
The hospitalization medical expenses exceeding the maximum payment limit of 654.38+10,000 yuan are mainly paid by the medical assistance fund. Payment methods: medical assistance fund pays 60%, the insured unit pays 30%, and the individual pays 654.38+00%. No unit personnel or non-file retirees are paid 60% by the medical assistance fund and 40% by individuals. Retirees from transformed enterprises and retirees without units and files will be paid 80% by medical assistance fund and 20% by individuals.
Special examination and special treatment during hospitalization shall be carried out according to the Interim Provisions on the Administration of Basic Medical Insurance for Urban Workers in Wujin City, and the accumulated payment shall be calculated by sections in the hospitalization expenses.
The expenses incurred by the resettlement personnel for traveling, visiting relatives and taking vacations in different places shall be reimbursed to the municipal medical insurance center within three months with personal IC card, medical records, list of medical expenses discharged from hospital and valid bills (resettlement personnel with medical certificates in different places).
The list of hospitalized drugs shall be implemented according to the scope of reimbursement of publicly-funded medical drugs in Changzhou (1997 edition), the scope of reimbursement of publicly-funded medical drugs in Jiangsu Province (1998 third edition) and the national basic medical insurance drug list and the prescribed Class A list (2000 edition). If the country or province has a new drug list, it can be used at the same time.
(d) fund management
The overall hospitalization expenses of enterprises shall be included in the financial accounts, separately accounted for, earmarked and audited annually, and shall not be misappropriated and audited regularly. It is managed by Wujin employee medical insurance fund management center.
Four, where enterprises and employees have been included in medical insurance coverage, hospitalization expenses must be paid continuously, without interruption. If it is necessary to re-participate in the insurance after the interruption, the medical co-ordination fee shall be supplemented during the interruption period, and a late fee shall be charged according to the Provisional Regulations on the Collection and Payment of Social Insurance Fees.
Five, into the scope of insurance enterprises, employees and retirees need * * * with insurance. Retirees must be insured within the specified time. If the employee fails to participate in the insurance within the specified time, the enterprise shall pay the corresponding medical compensation when participating in the insurance, with the standard of 480× (life expectancy-actual age). If it is difficult for the restructured enterprise to pay, the asset management company in charge of the industry will pay in the asset income; If it is really difficult for an asset management company to pay, it shall be solved by the municipal finance. In the future, if the on-the-job employees ask for insurance again, they should pay back the medical insurance fund, with the amount of 480×[ 15- (legal retirement age-actual age)]; Female employee: 480×[ 10 year old-(legal retirement age-actual age)]. Those who meet the conditions for early retirement can be included in the early retirement period.
Six, the labor and personnel agency belongs to non retirees should pay the hospitalization expenses from the month of the implementation of these measures, and continue to pay. Individuals who interrupt themselves shall be deemed to be no longer insured, and shall not go through the formalities of re-insurance in the future.
Seven, this approach since 2002 1 month 1 implementation.
Eight, these Measures shall be interpreted by the Municipal Labor and Social Security Bureau.
Wujin labor and social security bureau
Wujin bureau of finance
Wujin health bureau
November 18th, 200 1 year