Full text of medical insurance payment notice for urban and rural residents in Nanyang city
First, the insured object
Anyone who is not covered by the basic medical insurance for urban workers within the administrative area of our city shall participate in the basic medical insurance for urban and rural residents.
Second, the payment time.
The deadline for payment of basic medical insurance for urban and rural residents is 65438+February 3 1.
The centralized payment time is 10,15—110,30;
The specific time arrangement of centralized payment through the community is subject to the notice of my county.
Third, the payment standard
According to the regulations, the individual payment standard of basic medical insurance for urban and rural residents is 280 yuan.
Fourth, the mode of payment
Residents who meet the insurance conditions mainly pay fees through the community.
Full-time college students in our city are paid by the school.
Foreigners with residence permits can participate in the basic medical insurance for urban and rural residents at their place of residence. Residents who have registered for insurance can also complete individual payment through diversified payment methods such as "Henan Taxation" WeChat official account, Alipay, "Online Taxation Bureau-Henan Provincial Taxation Bureau" mobile APP, self-service tax terminal, and contracted bank outlets. If you haven't gone through the insurance formalities, please go to the community or medical insurance center where your household registration belongs as soon as possible, and then pay the fee in the above way; Residents who use diversified payment methods should check their insured places before completing the payment.
Verb (abbreviation of verb) medical insurance benefits
Residents who were insured before 65438+February 3 1 enjoy the basic medical insurance benefits of 202 1 to 1 to 202 1.
Basic medical insurance benefits The basic medical insurance benefits for urban and rural residents include general outpatient medical care, outpatient medical care for chronic diseases, medical care for serious and serious diseases and hospitalization.
1, general outpatient service. Insured persons seek medical treatment in designated medical institutions that meet the designated conditions, and outpatient compliance expenses are reimbursed at a rate of 50%. In a natural year, the personal capping line is 260 yuan, which can be used by insured family members. Insured residents who are covered by "hypertension and diabetes" need to take medicine. First of all, they should be given medication security according to the outpatient co-ordination policy. After the annual quota of outpatient co-ordination is used up, the annual increase of hypertension is 150 yuan, and the annual increase of diabetes is 170 yuan. If you have hypertension and diabetes at the same time, the 200 yuan quota will be increased every year. After the limit is raised, the combined fee will be reimbursed at the rate of 50%. If the balance of the original personal account is unclear, it can continue to be used in designated medical institutions.
2. Outpatient chronic diseases. At present, our city has included 19 chronic outpatient diseases. After the insured residents have passed the identification of chronic diseases, there is no threshold for outpatient medical expenses that meet chronic outpatient diseases, and 65% of them are reimbursed, and fixed-point treatment and quota management are implemented.
3. Serious and serious diseases. There is no Qifubiaozhun for medical expenses incurred by insured residents who meet the standards of serious diseases in our province and city. There are 33 kinds of inpatients with serious diseases, and the medical expenses within the price limit standard are paid by the basic medical insurance fund in proportion, with 80% of county-level medical institutions, 70% of municipal medical institutions and 65% of provincial medical institutions; There are 35 kinds of serious illness clinics, and the outpatient medical expenses that meet the requirements within the quota standard are included in the payment scope of the basic medical insurance pooling fund, and the payment ratio is 80%.
4. Hospitalization. Qifubiaozhun and reimbursement ratio of insured residents in hospital are as follows:
Maximum payment limit The annual maximum payment limit of the urban and rural residents' basic medical insurance pooling fund is 6.5438+0.5 million yuan.
Financing mode of serious illness insurance
Serious illness insurance funds are allocated from the basic medical insurance fund for urban and rural residents, and insured residents do not have to pay fees, focusing on compensating high medical expenses to further improve the medical security level of insured residents.
Reimbursement Policy After the hospitalization medical expenses incurred by the insured residents in an insurance year are reimbursed by the basic medical insurance, the part of the medical expenses borne by individuals that exceeds1.1.million yuan within the policy scope shall be reimbursed by the serious illness insurance fund according to the following proportion:1.1.. The part of more than 654.38+ 10,000 yuan shall be reimbursed at 70%.
Maximum payment limit The maximum payment limit for major illness insurance in that year is 400,000 yuan.