What are the specific contents of the Notice of Dezhou City on Doing a Good Job in Basic Medical Insurance for Urban and Rural Residents in 20 17? It is reported that in order to further consolidate and improve the basic medical insurance system for urban and rural residents in our province, accelerate the establishment of a more equitable and sustainable universal medical insurance system, and continuously improve the level of protection, we will now do a good job in the basic medical insurance for residents in 20 17 years in accordance with the national and provincial decision-making arrangements for comprehensively deepening medical reform. The following is a detailed introduction!
In order to further consolidate and improve the basic medical insurance system for urban and rural residents in our province, accelerate the establishment of a more equitable and sustainable universal medical insurance system, and continuously improve the level of protection, according to the national and provincial decision-making arrangements for comprehensively deepening medical reform, we hereby make a notice on doing a good job in the basic medical insurance for residents for 20 17 years (hereinafter referred to as residents' medical insurance) as follows:
The first is to adjust the funding standards for residents' medical insurance.
Based on the local economic and social development level and residents' economic affordability, in 20 17 years, the annual per capita medical insurance payment of residents in the whole province will be no less than 150 yuan. Finance at all levels should raise the subsidy standard according to the regulations. In accordance with the principle of balance of income and expenditure of the basic medical insurance fund, we will actively explore the establishment of a dynamic adjustment mechanism linking individual payment standards with residents' income, and gradually increase the proportion of individual payment in financing.
Second, fully realize municipal co-ordination.
In strict accordance with the requirements of document Lu [20 13]3 1, in 20 17 years, the residents' medical insurance fund will be coordinated at the municipal level, and the insurance payment, drug list, diagnosis and treatment policy, handling process, information system, budget management and fund management will be standardized and unified throughout the city.
Since 20 17, the provincial subsidy funds have been approved by the city and fully allocated to the city. The financial departments of cities and counties shall timely and fully allocate the subsidy funds that should be borne by the finance at the corresponding level according to the number of insured payers, establish and implement the pre-allocation system of medical insurance funds, and ensure that all the financial subsidy funds of cities and counties are in place before the end of August each year. Financial subsidies at the city and county levels shall be collected in the municipal social security account in accordance with the requirements of municipal unified revenue and expenditure. After the implementation of municipal overall revenue and expenditure, cities should establish a revenue and expenditure management model and a gap sharing mechanism in which the municipal and county (city, district) governments are responsible at different levels, carry out their duties and share risks, implement the responsibility of the county (district) medical insurance management department, mobilize the enthusiasm of all parties, and continuously improve the quality of municipal overall operation of basic medical insurance.
Third, stabilize the coverage of basic medical insurance.
We will implement the national enrollment registration plan, improve the family-based enrollment policy for urban and rural residents and the school-based enrollment policy for students, focus on the implementation of government subsidy policies for special groups, and ensure that all poor people and severely disabled people with file cards are enrolled. Increase the publicity and guidance of the payment adjustment policy, and avoid reducing the enthusiasm of participating in insurance because of the improvement of individual payment level. Strengthen the linkage between departments, expand convenient and quick channels for insurance payment, speed up the establishment of a stable insurance mechanism, and stabilize the participation rate of basic medical insurance for urban and rural residents at over 95%.
Fourth, ensure the payment of medical insurance benefits.
It is necessary to deepen the reform of medical insurance payment methods, promote the control of the total amount of medical insurance payment, and improve the composite payment method that combines various payment methods such as per head and disease. Municipalities should reasonably guide residents' expectations of basic medical insurance benefits according to the fund's ability to pay, and steadily improve the payment level within the policy scope of hospitalization expenses, and the reimbursement ratio of hospitalization expenses within the policy scope will reach about 70%. We will improve the outpatient support mechanism focusing on severe and chronic diseases and gradually improve the level of outpatient support. We will improve the serious illness insurance system for urban and rural residents, further clarify the responsibility and scope of payment of basic medical insurance and serious illness insurance benefits, and achieve balanced development of basic medical insurance and serious illness insurance. Transfer the serious illness insurance funds of commercial insurance companies on schedule and establish serious illness treatment compensation? Green channel? Ensure that the medical insurance accurate poverty alleviation policy is fulfilled in time. Strengthen the seamless connection between basic medical insurance, serious illness insurance and medical assistance, form a joint force of protection, and effectively prevent family catastrophic medical expenses.
Verb (abbreviation of verb) strengthens medical insurance supervision
Municipalities should strengthen the responsibility for rectification of audit problems and implement it? Number one? Take overall responsibility, carefully analyze the reasons for the problems found in the audit, draw inferences from others, and earnestly implement the rectification. Municipalities should combine the problems found in the audit, improve the internal control management mechanism of medical insurance funds, strengthen internal audit, fully implement the real-time reconciliation system between medical insurance agencies and financial, commercial insurance institutions and medical institutions, and ensure the timely collection, disbursement and payment of funds. Before the end of the year, it is necessary to complete the third-party evaluation of commercial insurance undertaking residents' serious illness business, and do a good job in business undertaking and work docking. Accelerate the application of the unified medical insurance intelligent supervision system in the whole province, extend the supervision focus to medical service behavior, realize the whole process supervision of medical behavior before, during and after the event as soon as possible, reduce the unreasonable increase of medical expenses, and effectively improve the utilization efficiency of medical insurance funds.
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65438128 October, the reporter learned from the Human Resources and Social Security Bureau of Decheng District that the collection of pension and medical insurance for urban and rural residents in 20 17 will be fully launched on June 28+065438+128 October, and residents can bring relevant materials to their townships (June 28 +2
It is understood that all urban and rural residents who are not included in the basic pension and medical insurance system for urban workers can participate in the pension and medical insurance for urban and rural residents. Payment time is1October 20161to February 2016123. At the same time, the staff of Decheng District Human Resources and Social Security Bureau hereby reminds residents to apply for insurance as soon as possible, and don't miss the payment time.
In 20 17, the individual payment standard of medical insurance for urban and rural residents was adjusted to 170 yuan per person per year. After the insured person pays the residents' basic medical insurance premium in full in one lump sum during the payment period, he can enjoy the residents' basic medical insurance benefits for the next year according to the medical year, and the treatment period is 10/0/to 1 to February 1.
In 20 17 years, the payment standard of residents' old-age insurance is still implemented according to 100 yuan to 5,000 yuan per person per year and 12 yuan, among which 100 yuan is still applicable to severely disabled people, and low-income poor households can also pay the minimum 100 yuan, and other insured people can choose their own payment grades.
When urban residents apply for insurance for the first time, they should bring their household registration book, the original and photocopy of their ID cards and 1 inch color (white background) recent bareheaded photos 1 piece to the human resources and social security service institutions in towns (streets) where their household registration is located to go through the insurance registration procedures. Rural residents go through the insurance registration formalities in the village where the household registration is located, and the village uniformly collects the residents' medical insurance insurance premium.
Students and children in the park shall go through the formalities of participating in residents' medical insurance by their schools and kindergartens. Newborns born on 20 17 can enjoy medical insurance benefits this year with their mothers' insured status. If the mother does not participate in the residents' medical insurance, she can enjoy the residents' medical insurance benefits within this year as long as she goes through the formalities of participating in the residents' medical insurance and pays the fee within 6 months after birth.
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