Medical Insurance Policy for Urban and Rural Residents in Zhangjiakou in 2022
First, the insurance payment
1, payment standard:
In 2022, the individual contributions of medical insurance for urban and rural residents will be 320 yuan per person, among which the individual contributions of the extremely poor, key entitled groups, severe disabilities (1, Grade 2) and survivors of retired cadres will be fully funded by the government, and individuals do not need to pay; The poverty-stricken population is funded by 90%, that is, each person pays 32 yuan; Urban and rural subsistence allowances are funded by 60%, that is, each person pays 128 yuan. Multi-identity personnel are funded according to the highest funding standards.
2. Payment method:
Continuous insured persons (including poverty-stricken people and subsistence allowances) can pay through mobile phones, payment terminals, tax bureau windows, village (neighborhood) committees, etc. (click to view the payment process of each channel), and pay attention to check whether the payment amount is consistent with the amount of personal payment.
New insured persons or newborns need to register their insurance information at the village committee, township or medical insurance department first, or they can register their insurance information through mobile phone self-service (click to view the one-stop clearing process of insurance payment), and then pay through the above payment methods.
Note: Newborns who pay within 3 months of birth will enjoy medical insurance benefits from the date of birth, and those who pay after 3 months will enjoy medical insurance benefits from the month after payment. No payment, no medical insurance benefits.
II. Basic medical insurance benefits for urban and rural residents
(A) outpatient co-ordination treatment
Insured residents seek medical treatment in secondary or above medical institutions in Hebei Province, village clinics, township hospitals, community health service stations or community health service centers, and the expenses in line with the medical insurance catalogue are included in the scope of outpatient co-ordination reimbursement. The reimbursement rate is 50% in 50 yuan from the beginning of the year, with the maximum reimbursement per year 150 yuan. The personal account balance accumulated during 20 17-2020 can still be used.
(2) Treatment of chronic and special diseases in outpatient department
* * * 30 diseases in 5 categories
The first category (4 kinds):
Hypertension level III high risk and above, chronic heart failure, diabetes (with serious complications), rheumatoid arthritis (with serious limb dysfunction). Within the scope of the policy, the reimbursement rate is 50%, with the quarterly capping line in 300 yuan and the annual capping line 1200 yuan.
The second category (7 kinds):
Myocardial infarction (including after coronary stenting and coronary artery bypass grafting), sequelae of cerebrovascular disease (with serious dysfunction), chronic moderate and severe viral hepatitis, liver cirrhosis, active tuberculosis, Parkinson's disease and brucellosis. Within the scope of the policy, the reimbursement rate is 55%, with the quarterly capping line in 500 yuan and the annual capping line of 2,000 yuan.
Category III (1 1 species):
Aplastic anemia, systemic lupus erythematosus, epilepsy, myasthenia gravis, scleroderma, Sjogren's syndrome, infantile cerebral palsy, rheumatic heart disease, cor pulmonale, chronic nephritis, mental disorder, psychosis (schizoaffective mental disorder, severe mental retardation). Within the scope of the policy, the reimbursement rate is 60%, the quarterly ceiling line 1000 yuan, and the annual ceiling line is 4000 yuan.
The fourth category (7 species):
Mental illness (schizophrenia, paranoid psychosis, epileptic psychosis, bipolar disorder), the reimbursement rate within the policy scope is 60%; Malignant tumor, organ transplantation, leukemia, hemophilia, pulmonary hypertension, the reimbursement rate within the policy scope is 75%; The reimbursement rate within the scope of end-stage renal disease policy is 82%.
Category V (1 species):
For phenylketonuria, the reimbursement rate is 70% for the purchase of special food and the expenses of blood phenylalanine testing and physical examination, with an annual cap of 14000 yuan, and the cumulative maximum is190,000 yuan.
Insured residents can go to any designated hospital in Hebei Province for medical treatment and purchase medicines, and be reimbursed directly in the hospital. In addition, you can also choose a designated hospital below the second level and a township health center as an outpatient hospital for chronic and special diseases. Patients who have long-term residence outside the province can choose a designated medical institution. You can also choose Internet Hospital (the First Hospital of Zhangjiakou City) and * * * Enjoy Pharmacy (Huatuo Pharmacy) for a follow-up visit.
Query process of designated medical institutions
(3) Hospitalization treatment
The deductible is deducted for each hospitalization. For those hospitalized for many times in a natural year, the deductible is reduced by 10% in turn, but the minimum is not lower than that in 300 yuan. Hospital delivery allowance 1000 yuan, caesarean section allowance 2000 yuan. Postpartum complications are the same as hospitalization reimbursement. From September, 2002 1 year/0/day, our province has implemented the reimbursement policy of "medical treatment in the province is the same as that in the designated medical institutions in Hebei Province", and all those who are hospitalized enjoy the same policy treatment as the medical institutions at the same level in the insured place. Those who are hospitalized in some medical institutions in Beijing and Tianjin, which are included in the designated hospitals in Hebei Province, can also enjoy the same policy treatment as the medical institutions at the same level in our city.
Third, the reimbursement of serious illness insurance benefits
Major illness insurance for rare diseases: those who have registered in Hebei Province, participated in the basic medical insurance in Hebei Province and have paid for it continuously for 3 years, or participated in the basic medical insurance for urban and rural residents in Hebei Province, are under 3 years of age, and one of their parents has participated in the basic medical insurance in Hebei Province and paid for it continuously for 3 years. Patients diagnosed with Gaucher's disease and Pompeii's disease by designated hospitals can enjoy treatment according to the major medical insurance for ordinary urban and rural residents.
Fourth, medical assistance
(a) general outpatient medical assistance
Poverty-stricken people, destitute people, and low-income people, after being reimbursed by the basic medical insurance, will be given 50% of the annual compliance medical expenses, with the maximum amount of 500 yuan.
(2) Outpatient medical assistance for chronic and special diseases
Poverty-stricken people, destitute people, and low-income people, after being reimbursed by basic medical insurance and serious illness insurance, whose annual compliance medical expenses are more than 1000 yuan, will be rescued by medical assistance funds according to the proportion of 70%, and the annual relief limit will not exceed 20,000 yuan.
(3) Hospitalization medical assistance
After being reimbursed by basic medical insurance and serious illness insurance, the poverty-stricken population, poor people and low-income people will be given 80% of the annual compliance medical expenses, with a maximum limit of 70,000 yuan.
(four) serious illness hospitalization medical assistance
After basic medical insurance, serious illness insurance reimbursement and hospitalization medical assistance, 90% of the medical expenses borne by individuals who exceed the annual maximum amount of hospitalization medical assistance will be rescued, with the maximum amount of 200,000 yuan.
V. Process of seeing a doctor
(A) outpatient co-ordination
With medical insurance electronic certificate or social security card to the designated medical institutions, direct reimbursement.
(B) Outpatient "two diseases"
Patients with "two diseases" go to the designated medical institutions for identification, and after identification, they will be reimbursed directly by purchasing medicines at designated medical institutions with medical insurance electronic certificate or social security card.
(3) Outpatient chronic and special diseases
Designated hospitals in Hebei Province or * * * enjoy pharmacies, with medical insurance electronic certificate or social security card directly reimbursed in designated hospitals. If the designated hospital is outside Hebei Province, it shall wait until the residents' medical insurance window for reimbursement with ID card, bank card, original invoice and expense list.
(four) hospitalized in hospitals in Hebei Province, with medical insurance electronic certificate or social security card directly reimbursed when discharged from the hospital. Those who are hospitalized outside Hebei Province will be put on record through the WeChat self-service filing system before admission (click to view the self-service filing process), or they will be put on record at the medical insurance window with relevant documents before admission (or they can be contacted by telephone or WeChat for filing), and they will be reimbursed directly at the hospital after discharge. For hospitals that cannot be directly settled due to objective reasons, they will be reimbursed at the medical insurance window with relevant materials after discharge.
(5) "One-stop" settlement of poverty-stricken people, destitute people and low-income objects, and "one-stop" settlement with triple guarantees. When reimbursement is made at the hospital or medical insurance window, basic medical insurance, serious illness insurance and medical assistance will be reimbursed at one time. Other personnel to implement basic medical insurance, serious illness insurance one-stop reimbursement, medical assistance to the household registration to apply for, by the village, township and county after the audit to give assistance.
(six) other matters such as patients who participate in other commercial insurance, first reimbursement of basic medical insurance before commercial insurance reimbursement.
Sixth, the medical insurance electronic certificate is activated
Insured persons should activate the medical insurance electronic certificate in time. After activating the medical insurance electronic certificate, they can carry out all medical insurance-related businesses such as medical insurance registration, drug purchase and settlement without carrying a social security card. If they forget their passwords, they can also reset them on their mobile phones, which is safe and fast. One code can be used for all (click to view the activation process of medical insurance electronic certificate). Older children who don't have smart phones can activate them through the family account of medical insurance electronic certificate (click to view how to activate medical insurance electronic certificate).