First, the payment base:
Urban workers
1, and the individual contribution base of employees is the average monthly salary of employees in the previous year;
2. If the employee's monthly salary in the previous year is higher than the average monthly salary of urban employees in the previous year by 300%, it will not be included in the payment base;
3, less than 60% of the average monthly salary of urban workers in the previous year, 60% of the average monthly salary of urban workers in the previous year as the payment base.
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1, the elderly residents to 300 yuan;
2. Individual residents pay 400 yuan;
3, children and newborns according to 80 yuan standards;
4. Individual insured residents who hold valid Yangzhou Residents' Minimum Living Security Assistance Certificate, People's Republic of China (PRC) Disabled Persons' Card (disability 1 or Grade 2) and extremely poor employees' cards do not pay fees.
Second, the payment ratio:
Individuals bear 2%, and units bear 8%.
Third, the payment standard:
(A) individual payment standards
1, ordinary urban and rural residents
Personal payment temporarily implements the "one system and two files" payment standard (personal payment sets high-grade and low-grade standards), and gradually transitions to the same payment standard in about 3 years.
Annual low standard of individual payment 180 yuan/person? In, the high-grade standard of individual payment was 300 yuan/person? A few years.
The original insured of the new rural cooperative medical system can voluntarily choose the personal payment grade, which cannot be changed within a medical insurance year, and the personal payment grade is linked to the level of treatment. Medical insurance premiums paid by individual urban and rural residents will not be refunded after entering the treatment enjoyment period.
Elderly residents and ordinary residents who participate in medical insurance for urban residents shall pay their personal expenses according to the high-level standard of individual contributions.
2. Students and children
(1) The payment method for student insurance has been issued separately.
(2) The individual payment standard for minor residents and newborns who are not enrolled in school (nursery) is 130 yuan/person? Years (enjoy the medical insurance benefits of urban and rural residents with high-level personal payment standards), and if there is any adjustment to the personal payment standards in the future, it shall be implemented according to the adjusted standards.
(B) financial subsidy standards
Financial subsidy standards shall be implemented in accordance with the relevant provisions of the state, province and city.
(three) to meet the conditions of the insured individual payment in accordance with the provisions of funding.
Persons who meet one of the following conditions within the administrative area of this Municipality shall participate in the individual contributions of medical insurance for urban and rural residents as determined by relevant functional departments, and shall be fully funded by governments at all levels in accordance with the high-level standards for individual contributions.
1. Key medical assistance targets: family members with minimum living guarantee with local household registration, destitute dependents, seriously ill patients among temporary assistance targets, retired workers who were downsized in the 1960s and enjoyed regular and quantitative living allowance from civil affairs departments, key special care recipients, orphans who enjoyed basic living guarantee from the government, and destitute workers approved by the municipal and county Federation of Trade Unions;
2. Establish a file for low-income people;
3 severely disabled persons who have lost their ability to work and other eligible medical assistance objects.
IV. Term of payment:
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Individuals who participate in the basic medical insurance for employees must continue to pay fees to the statutory retirement age. When reaching the statutory retirement age, the cumulative minimum payment period (the sum of the deemed payment period calculated according to regulations and the actual payment period of employee basic medical insurance) must reach 25 years for men and 20 years for women, of which the actual payment period is not less than 15. No longer pay the basic medical insurance premium after retirement, and enjoy the basic medical insurance benefits for retirees according to regulations.
If the cumulative minimum payment period and the actual payment period have not reached the prescribed period, the basic medical insurance for employees of the employer shall enjoy the basic medical insurance benefits for retirees after paying the medical insurance premium for poor years in a lump sum according to the regulations.
Verb (abbreviation of verb) payment method:
Insurance payment method
1, ordinary urban and rural residents and minor residents who are not insured (entrusted) shall apply for insurance registration and individual premium collection in a unified manner in their communities and administrative villages; Non-local residents holding residence permits shall go through the formalities of insurance registration and payment in their communities and administrative villages.
2, students and kindergarten children, to the school (kindergarten) as a unit, unified registration and personal insurance premium collection. Within 3 months from the date of birth of a newborn, its legal guardian shall go to the community and administrative village where the household registration is located to handle the insurance registration and related payment procedures with the newborn household registration book.
3, the Township People's government, street offices responsible for the local urban and rural residents medical insurance fund raising and policy propaganda. Villagers' committees and residents' committees shall assist township people's governments and sub-district offices to do a good job in medical insurance for urban and rural residents.
The municipal medical insurance department issued a notice, and the payment period of centralized medical insurance for urban and rural residents in our city in 20021year is from now until 12.30. Compared with last year, in 20021year, the medical insurance payment of ordinary urban and rural residents was adjusted to 400 yuan, and students and children (school students, underage residents who have not entered kindergarten, newborns) were still in 240 yuan.
It is reported that the medical insurance reimbursement policy of 202 1 has also changed greatly. If the reimbursement rate within the scope of major illness insurance policy is increased from 50% to more than 60%, the outpatient medication of patients with "two diseases" who participate in residents' medical insurance and meet the diagnostic criteria of hypertension and diabetes will be included in the special guarantee.
Scope of insurance object
Urban and rural non-employed residents with household registration in this Municipality;
Students in school (kindergarten children, primary and secondary school students, full-time students in institutions of higher learning and vocational and technical schools), minor residents and newborns who are not enrolled in school;
Non-employees who have obtained residence permit in Yangzhou and are not registered in this city;
Other personnel who meet the requirements. Students at school are not restricted by household registration, but may not be insured again.
Insurance mode
Ordinary urban and rural residents and minor residents who are not insured (entrusted) shall go through the registration procedures of insurance by their communities and administrative villages; Within 3 months from the date of birth of the newborn, its legal guardian shall go through the insurance registration formalities in the community and administrative village where the household registration is located with the newborn household registration book; Non-employees who hold residence permits and are not registered in this Municipality shall go through the insurance registration procedures in the community or administrative village where they live.
Students in school are registered by the school (child care institution). Local medical insurance agencies should strengthen communication and coordination with local schools and optimize the process of insurance payment. In June, 2020,10-1,medical insurance agencies at all levels, taking schools as units, transmitted the effective enrollment registration information of students in the current year to the tax authorities according to new insurance types, and the insurance types were valid until August 3 of the following year. The insurance information of the last year registered by the above-mentioned personnel before August 3 1 of that year will automatically become invalid.
payment types/methods
There are four main payment methods: bank inquiry payment, tax window centralized declaration payment, online payment and self-service terminal payment.
Bank-side inquiry payment refers to that ordinary residents go through the relevant payment procedures at the outlet window of the handling bank with their ID card (residence permit) after registering for insurance; Minor residents and newborns who are not enrolled in school (in the park) shall go through the relevant payment procedures at the outlet window of the handling bank with their ID card (residence permit) and the "Yangzhou Urban and Rural Residents' Medical Insurance Payment Confirmation Form" issued by the community and administrative village.
The centralized declaration and payment in the tax window refers to the township (street), village (community), school and other units that centrally handle the medical insurance registration for urban and rural residents to go to the window of the local tax authorities for summary declaration and payment. The agency shall provide the payer's name, ID number, payment period, payment amount and other detailed information in the prescribed format.
Online payment means that the payer handles relevant payment through online payment channels such as WeChat and Alipay.
Self-service terminal payment means that the payer handles the relevant payment through self-service terminal equipment such as tax silver POS machines.
Insurance payment time
From now until February 30, 2020, the payment period of centralized medical insurance for urban and rural residents will be 202 1.
Financing methods and standards
Medical insurance for urban and rural residents shall be financed by combining individual contributions with government subsidies, and individual contributions shall be subject to the annual payment system.
Individual payment standard: 1. Ordinary urban and rural residents: The individual payment standard of 202 1 is 400 yuan/person. Medical insurance premiums paid by urban and rural residents will not be refunded after they enter the treatment enjoyment period (202 1 to 202 1, 1, 65438+2, 3 1) (except for repeated payment and wrong payment standard selection). 2. Students and children: In 20021year, students, underage residents (kindergartens) who have not enrolled in school and newborns pay 240 yuan per person, enjoying the same enjoyment as ordinary urban and rural residents. Newly enrolled students who are insured for the first time in this city will enjoy the corresponding medical insurance benefits for urban and rural residents from the date of school registration (1 September and after) after obtaining their school status and paying the medical insurance premiums for urban and rural residents in full and on time (those who have been insured in other places and are within the treatment period shall not enjoy the benefits repeatedly). In 20021year, the general outpatient expenses of college students were used and managed according to the standard of 65 yuan/person for each insured student.
Financial subsidy standard: the financial subsidy standard of medical insurance for urban and rural residents shall be implemented in accordance with the standards not lower than those stipulated by the state and the province.
Financing standard of serious illness insurance: according to the relevant regulations of the state and the province, it is clear that the financing standard of serious illness insurance in the city in 2020 is 75 yuan/person; In 20021year, the financing standard of serious illness insurance in this city was implemented in accordance with the relevant provisions of the state and the province.
For those who meet the conditions and have difficulty in participating in the individual payment of medical insurance for urban and rural residents, full funding will be given. Within the administrative area of this Municipality, key medical assistance objects, low-income people with filing cards, severely disabled people who have lost their ability to work and other eligible medical assistance objects are recognized by relevant functional departments and participate in the individual contribution of medical insurance for urban and rural residents, and are fully funded by governments at all levels.
Medical insurance reimbursement policy
Compared with previous years, the medical insurance reimbursement policy of 202 1 has changed obviously. (a) the proportion of reimbursement within the scope of serious illness insurance policy increased from 50% to more than 60%; (two) to participate in medical insurance for residents and meet the diagnostic criteria of hypertension and diabetes, and it is really necessary to see a doctor. (3) The state negotiates to include drugs in medical insurance reimbursement, etc.