Article 1 These Measures are formulated in light of the actual situation of this Municipality in order to reduce the family financial burden of minors seeking medical treatment due to injuries, facilitate the healthy growth of children, establish and improve a multi-level medical security system, and build a harmonious society.

Article 2 The medical insurance for minors as mentioned in these Measures refers to the social medical mutual aid and economic aid system which is led by the government, combined with financial subsidies and family contributions, and mainly based on the overall medical care for serious illness.

Article 3 Minors under the age of 18 who have registered residence in this Municipality within the administrative area of this Municipality shall participate in medical insurance for minors according to these measures.

Registered students who have registered residence in this city and are over the age of 18 in high schools, technical secondary schools, special schools, technical schools and vocational schools approved by relevant government departments should participate in medical insurance for minors according to these measures.

Those who have participated in the new rural cooperative medical system in the above-mentioned insured objects may continue to participate in the medical insurance for minors according to the original measures or in accordance with the provisions of these measures.

Non-registered students studying in primary schools, junior high schools and senior high schools in this city, whose father or mother signed a labor contract with the employer in this city and paid social insurance premiums, shall participate in medical insurance for minors according to these measures.

Article 4 Medical insurance for minors adheres to the principle of basic guarantee and wide coverage; The principle that the level of security is compatible with the level of economic development in this Municipality; Adhere to the principle of pay-as-you-go and balance of payments.

Article 5 The municipal labor and social security department is responsible for organizing and implementing the medical insurance for minors in this Municipality. Finance, health, education, local tax and other relevant departments should cooperate with the labor and social security departments to do a good job in the implementation of these measures.

In accordance with these measures, the students (including children in kindergartens and nurseries) who should be insured shall be responsible for the collection and payment of medical insurance premiums by their schools (including kindergartens and nurseries), and shall go through the formalities of registration and payment of medical insurance premiums with the local tax authorities in a unified manner; Other minors apply for registration and payment of medical insurance premiums to the local tax authorities where their household registration is located.

Social insurance agencies specifically undertake medical insurance business for minors. Xiamen Social Insurance Management Center (hereinafter referred to as the Municipal Social Security Center) is responsible for the use and management of the city's minor medical insurance fund, and do a good job in data statistics and business guidance for district-level social insurance agencies.

Article 6 The medical insurance fund for minors is mainly composed of funds subsidized by the government and medical insurance premiums paid by individuals. The sources of the fund are as follows:

(a) the financial sector to the insured minors according to the standard of 50 yuan per person per year to give subsidies. The subsidy funds shall be borne by the municipal and district governments, 50% respectively.

(two) the insured individual minors pay medical insurance premiums according to the standard of 80 yuan per person per year.

Article 7 Minors who hold the Xiamen Minimum Living Guarantee Certificate and receive the minimum living guarantee for urban residents are exempted from paying medical insurance premiums, and the exempted part shall be borne by the municipal and district governments, 50% respectively.

Minors who hold the "People's Republic of China Disabled Persons' Card" are exempt from medical insurance premiums, and the exempted part shall be borne by the Employment Security Fund for the Disabled.

Article 8 The medical insurance year for minors is from July 1 day of each year to June 30th of the following year. The reporting and payment period of medical insurance for minors is from April 1 day to May 30th every year. Those who fail to apply for insurance or renewal of insurance within the prescribed reporting payment period can only apply for insurance or renewal of insurance and payment procedures within the reporting payment period of next year. The medical expenses incurred during the interruption period shall not be paid by the minor medical insurance fund.

Article 9 Within three months after the birth of a newborn, his parents or guardians shall go through the registration and declaration formalities with the local tax authorities where he is registered, pay the annual medical insurance premium according to the provisions of Article 6, and enjoy the medical insurance benefits for minors from the date of birth; Those who apply for registration after three months of birth will enjoy medical insurance benefits for minors from the month when they pay medical insurance premiums.

Tenth minors insured, the social insurance agency issued a social security card for them, as a special voucher for their medical treatment and settlement of medical expenses.

When the insured minors are sick, they should take their social security cards to the designated medical institutions of the basic medical insurance for urban workers for medical treatment.

Eleventh minor medical insurance for urban workers to implement the basic medical insurance drug list, diagnosis and treatment items, the scope of medical service facilities, as well as the commonly used pediatric drugs and diagnosis and treatment items supplemented by the municipal labor and social security administrative department.

Twelfth in a medical insurance year, the insured minors in outpatient medical expenses that meet the requirements shall be paid in the following ways, and the rest shall be paid by the medical insurance fund for minors. The outpatient medical expenses in the year shall be calculated cumulatively:

(a) medical expenses in 1000 yuan, all borne by the insured individuals;

(two) medical expenses in 1000 yuan, less than 5000 yuan, 80% of the insured individuals;

(three) medical expenses in 5000 yuan to 10000 yuan, 50% of the insured individuals;

(4) For the medical expenses above 10000 yuan, the insured individuals shall bear 40%.

Thirteenth in a medical insurance year, the insured minors hospitalization in accordance with the provisions of the medical expenses, the insured individuals to pay in the following ways, the rest paid by the medical insurance fund for minors, the medical expenses for multiple hospitalizations during the year accumulated:

(a) medical expenses less than 10000 yuan, in tertiary, secondary and primary medical institutions, the insured individuals bear 45%, 35% and 25% respectively;

(two) medical expenses 10000 yuan to 20000 yuan, in the third, second and first class medical institutions, the insured individuals bear 40%, 30% and 20% respectively;

(3) If the medical expenses are more than 20,000 yuan, the insured individuals will bear 35%, 25% and 15% respectively in tertiary, secondary and primary medical institutions.

Fourteenth in a medical insurance year, the maximum amount of hospitalization and outpatient medical expenses paid by the minor medical insurance fund for each insured minor is consistent with the maximum amount of medical expenses paid by the social pooling fund of the basic medical insurance for urban workers in this city; Medical expenses exceeding the maximum payment limit shall be solved by the municipal labor and social security administrative department in conjunction with the financial department.

Fifteenth insured minors medical expenses, has been paid by other insurance or the third party responsible person, the minor medical insurance fund will no longer pay.

Article 16 The municipal labor and social security administrative department shall, jointly with the financial department, put forward adjustment opinions on the payment standard, financial subsidy measures, medical insurance benefits for minors and the maximum payment limit according to the social and economic development of this Municipality and the operation of the medical insurance fund for minors, which shall be implemented after being approved by the municipal government.

Seventeenth insured minors due to illness need to be transferred to other places for hospitalization and long-term residence in different places for medical treatment, should be handled in accordance with the relevant provisions of the basic medical insurance for urban workers; If it is not handled in accordance with the regulations, the medical insurance fund for minors will not pay.

Medical expenses incurred by minors who are transferred to other places for hospitalization shall be borne by the individual 10% first, and then paid according to the provisions of Article 13 of these Measures.

Medical expenses incurred by insured minors abroad shall not be paid by the medical insurance fund for minors.

Eighteenth insured minors in a medical insurance year, medical expenses must be settled within three months after the start of the next medical insurance year (that is, before September 30), beyond the time, except for force majeure, the medical insurance fund for minors will not pay.

Article 19 The medical expenses incurred by insured minors in designated medical institutions that meet the requirements of basic medical insurance payment shall be settled with the designated medical institutions with my social security card, and the part paid by individuals shall be paid directly to the designated medical institutions by individuals in cash.

Twentieth designated medical institutions should refer to the relevant provisions of the basic medical insurance for urban workers to provide medical services for insured minors.

Designated medical institutions should adhere to the treatment due to illness, rational drug use, reasonable inspection, reasonable treatment and reasonable charges, and record the drug use and various inspections and treatments on the prescribed vouchers, provide a list of medical expenses, and accept the inspection and supervision of relevant departments.

Designated medical institutions should respect the right to know of patients or their relatives. In the use of self-funded drugs, medical consumables, diagnosis and treatment projects, it should be informed in writing in advance and obtained the consent of patients or their relatives.

Article 21 The medical insurance fund for minors shall be managed by special financial accounts, special funds and two lines of revenue and expenditure, and no unit or individual may misuse or misappropriate it. The municipal finance department shall, according to the payment of the medical insurance fund for minors, give the equivalent of 2 months' payment of working capital.

When the medical insurance fund for minors is insufficient to pay, it shall be solved by the municipal finance as a whole.

The operation of the medical insurance fund for minors is subject to social supervision and inspection and supervision by the municipal finance and auditing departments.

Twenty-second minor medical insurance in the process of implementation of the relevant disputes, by the disputing parties through consultation, consultation fails, can be submitted to the municipal administrative department of labor and social security.

Twenty-third city, district social insurance agencies to handle the medical insurance business for minors required funds, included in the fiscal budget, by the financial allocation.

Article 24 These Measures shall be implemented as of January 1st, 2007.