What is the minimum payment base of social security medical care in Chengde, Hebei and Beijing?

In order to continuously improve the medical security system in our city, according to the State Council's Guiding Opinions on Launching the Pilot Project of Basic Medical Insurance for Urban Residents (Guo Fa [2007] No.20) and Hebei Provincial People's Government's Implementation Opinions on Establishing the Basic Medical Insurance System for Urban Residents (Zheng Ji [2007] No.99), we now put forward the following implementation opinions on accelerating the construction of the basic medical insurance system for urban residents in combination with the actual situation in our city: 1. Adhere to the principle of social equity and make arrangements for different levels of medical security; Adhere to the principle of wide coverage, reasonably determine the financing level and security standards according to the level of economic development and the affordability of all aspects, and focus on ensuring the medical needs of non-employed residents in hospitals and outpatient clinics; Adhere to the principle of individual (family) voluntary payment, supplemented by government subsidies; Adhere to the principle of territorial management and equal rights and obligations; Adhere to the medical insurance fund "fixed expenditure by income, balance of payments, a slight balance" principle; Adhere to the principle of unified management and make a good connection with the basic policies, standards and management measures of various medical security systems. (2) objectives and tasks. All counties and districts in the city should start the basic medical insurance for urban residents in 2008, and gradually realize the coverage of non-employed urban residents in the city. Second, the scope and overall level of insurance (3) the scope of insurance. Non-employed urban residents who are registered in urban areas as a whole in this Municipality and are not covered by the basic medical insurance for urban workers and the new rural cooperative medical system include: students in secondary schools, ordinary high schools, junior high schools and primary schools, and minors and preschool children under the age of 18 ("over one year old" as stipulated in this article includes my age, "under one year old" does not include my age); Elderly residents who have reached the age of 50 for women and 60 for men and have no work unit; People who enjoy the minimum living guarantee in the city; Disabled persons with level 2 or above (including level 2, the same below); And other people who meet the conditions for insurance. Primary and secondary school students and kindergarten children who have been studying in cities and towns with their rural parents for many years may also voluntarily participate in the overall planning of basic medical insurance for urban residents. The medical security policy for college students shall be stipulated separately. (four) the convergence of the insurance system. Persons participating in the basic medical insurance for urban residents shall not participate in the basic medical insurance for urban workers or the new rural cooperative medical system at the same time. Those who have participated in the medical insurance for urban residents shall participate in the basic medical insurance for urban workers after establishing labor relations with the employer; The payment period of participating in the basic medical insurance for urban residents cannot be regarded as or converted into the payment period of participating in the basic medical insurance for urban employees. Those who have participated in the basic medical insurance for urban workers shall not be transferred to the basic medical insurance for urban residents in principle. Urban residents of working age should participate in the basic medical insurance for urban workers in principle. (5) Overall planning level. The overall level of basic medical insurance for urban residents and basic medical insurance for urban employees is consistent in principle. According to the actual situation of our city, Shuangqiao District, Shuangluan District and Ruth District implement municipal unified planning; Other counties implement county-level overall planning. Three. Financing level and subsidies (VI) Financing level. According to the local economic development level and the basic medical consumption needs of different groups such as adults and minors, and considering the affordability of local residents' families and finances, the overall planning areas should appropriately determine the financing level. The municipal fund-raising level is determined as:/kloc-350 yuan, an urban resident over 8 years old,/kloc-urban resident under 8 years old 150 yuan. County financing level can be determined with reference to the city level. (7) subsidies. According to the local financing standards, the regional government will pay the individual contributions of the insured residents and give subsidies according to age, group and year. In principle, various subsidies cannot be enjoyed repeatedly, and the specific subsidy standards are high or low. Subsidy funds should be included in the financial budgets of governments at all levels. The government subsidizes the insured residents at an annual per capita of not less than 100 yuan, in which the central and provincial governments respectively subsidize 40 yuan and the municipal governments subsidize 20 yuan. On this basis, for students and children with disabilities above the minimum living standard or level 2, the central and provincial governments respectively increase subsidies to 5 yuan, and the municipal governments increase subsidies to urban areas 10 yuan; For other low-income residents, people with disabilities above the second level, and elderly people over the age of 60 from low-income families, the central and provincial governments respectively increased subsidies to 30 yuan, and the municipal finance increased subsidies to 80 yuan. Municipal financial subsidies for urban insured residents take the form of municipal and district subsidies, and each city and district shall bear 50%. If the per capita available financial resources at the county level are lower than the average level of the whole city, the municipal finance will give some subsidies according to the specific circumstances. Counties determine their own subsidy standards according to their own financial situation, and areas with conditions can increase the scope and amount of subsidies. Four. Insurance payment and medical insurance benefits (8) Insurance payment. The annual enrollment and payment time of urban residents in the city is uniformly determined to start in September each year and end before 165438+ 10. The payment period of medical insurance benefits is 65438+ 10/0/to 65438+3 1 in February of the following year. According to the children's enrollment and graduation time, the payment time for secondary schools, primary and secondary schools and kindergartens is determined to be from September/kloc-0 to September 30 every year. The insured person pays the medical insurance premium for one year at a time, and enjoys the medical insurance treatment for one year accordingly. School students and kindergarten children take schools and kindergartens as units, and other personnel take families as units to pay insurance premiums within the prescribed payment time. The basic medical insurance for urban residents is mainly paid by individuals (families), supplemented by government subsidies. Conditional employers can give subsidies for insurance contributions to the families of employees. The state formulates preferential tax policies for individual contributions and unit subsidy funds. Insured residents should pay the basic medical insurance premium for urban residents continuously. Those who fail to pay the medical insurance premium for the next year in full and on time will stop enjoying the medical insurance benefits from the next year (1+0). If the arrears are paid within 3 months, the medical insurance benefits will be restored from the month after the arrears are paid, and the medical expenses incurred during the arrears period will be borne by me; If it is not paid within 3 months, it will be regarded as automatically withdrawing from the basic medical insurance for urban residents. Re-insurance, according to the new insurance procedures, insurance waiting period, specifically determined by the overall planning area. (9) medical insurance benefits. The basic medical insurance for urban residents does not establish a personal account, and the medical insurance fund is mainly used to pay the reimbursement of medical expenses for hospitalization and outpatient serious illness of insured residents. Before the introduction of relevant national and provincial policies, the payment scope of the basic medical insurance fund for urban residents shall be implemented in principle with reference to the drug list, diagnosis and treatment items, medical service facilities and payment standards of the basic medical insurance for urban employees, and may be appropriately adjusted according to the actual situation. The basic medical insurance fund for urban residents shall set a minimum payment standard and a maximum payment limit. The minimum payment standards of municipal basic medical insurance fund are: 300 yuan, a first-class hospital, 500 yuan, a second-class hospital, and 800 yuan, a third-class hospital; The maximum payment limit of the basic medical insurance fund in a year is 40 thousand yuan. Other overall planning areas can determine their own Qifubiaozhun and maximum payment limit according to the fund's ability to pay and the local medical consumption level, and the Qifubiaozhun of community health service institutions can be appropriately reduced. Insured students and minors under the age of 18, children suffering from leukemia and malignant tumors, the maximum payment limit of the basic medical insurance fund at the city level is 80 thousand yuan, and other co-ordination areas can refer to the implementation. Medical expenses that meet the payment scope of the basic medical insurance fund for urban residents shall be borne by individuals below the minimum threshold and above the maximum payment limit; Above the Qifubiaozhun and below the maximum payment limit, the medical insurance fund and the insured residents shall bear the burden respectively according to the prescribed proportion, and the reimbursement level can be controlled at 50%-70%, which shall be determined by the overall planning areas according to the actual situation. For the medical expenses that the insured residents exceed the maximum payment limit, a large supplementary medical insurance system for urban residents can be established, and the specific measures shall be determined by the overall planning area. V. Management of basic medical insurance for urban residents (X) Fund management and supervision. The sources of the basic medical insurance fund for urban residents include: medical insurance premiums paid by insured individuals; Funds subsidized by the government financial department; Funds raised by other channels; Interest and value-added income of the fund. The basic medical insurance fund for urban residents shall be exempted from various taxes and fees in accordance with state regulations. The basic medical insurance fund for urban residents should be included in the financial accounts of social security funds for unified management, separate accounting and two lines of revenue and expenditure. Every year, 3% of the urban residents' basic medical insurance fund is extracted to establish a risk adjustment fund to adjust and make up for the loss risk of the urban residents' medical insurance fund. The audit department shall regularly audit the income and expenditure and the use of the basic medical insurance fund for urban residents, and make the audit results public. All co-ordination areas should strictly implement the financial system in accordance with the relevant provisions on the management of social insurance funds, strengthen the management and supervision of basic medical insurance funds, explore the establishment and improvement of fund risk prevention and adjustment mechanisms, and ensure the safety of funds. The funds used by governments at all levels to subsidize residents' participation in insurance shall be allocated to medical insurance agencies on time according to the actual participation of residents. Insured residents, designated medical institutions or other departments and personnel who defraud medical insurance benefits or medical insurance fund expenditures shall be ordered to return by the administrative department of labor security, and a fine of 1 times or more and 3 times or less shall be imposed; If a crime is constituted, criminal responsibility shall be investigated by judicial organs according to law. The administrative department of labor and social security, medical insurance agencies and agency staff abuse their powers, engage in malpractices for selfish ends or neglect their duties, which constitutes a crime, shall be investigated for criminal responsibility according to law; If it does not constitute a crime, it shall be given administrative sanctions. When the payment amount, financial subsidy amount, qifubiaozhun, maximum payment limit and personal conceit ratio formulated by the overall planning area can not meet the needs, with the approval of the overall planning area government, appropriate adjustments can be made according to the economic and social development and fund revenue and expenditure. (eleven) medical service management. The basic medical insurance for urban residents shall be managed by designated medical institutions, and the measures for the management of designated medical institutions shall be implemented with reference to the relevant provisions of the basic medical insurance for urban workers. Designated medical institutions at all levels should strictly implement the rules and regulations of the basic medical insurance for urban residents, strengthen internal construction, improve the medical service environment, rationally treat diseases and use drugs, and provide convenient, cheap and fast medical services. Designated medical institutions violate the medical insurance service agreement and bear corresponding responsibilities in accordance with the relevant provisions of the agreement; Damage or adverse effects on medical insurance work, given to informed criticism, ordered to make corrections within a time limit; Refuse to rectify or seriously violate the provisions, cancel the designated qualification. According to the medical characteristics of urban residents, take active and effective supervision measures, strengthen the management of medical expenses, and explore the establishment of a reward and punishment mechanism for medical service management. Actively promote the payment of medical expenses by disease, total prepayment, quota management and other settlement methods, establish a reasonable and safe cost settlement process, reduce procedures and facilitate patients. (twelve) to strengthen the construction of medical insurance management service institutions. According to the actual needs of carrying out the basic medical insurance for urban residents, all overall planning areas should strengthen the construction of medical insurance management service institutions, increase the necessary institutions, staffing and personnel, give full play to the role of existing medical insurance agencies and community labor and social security service institutions, and enrich the management service team through government-funded employment, purchase of services or use of re-employment public welfare post indicators. The government finance at the same level should solve the necessary work funds and special funds, and be included in the fiscal year budget at the same level. It is necessary to develop and improve the construction of medical insurance information system, establish and improve the management system and improve the operation mechanism to ensure the smooth development of basic medical insurance for urban residents. (thirteen) improve other medical security systems and deepen the reform of the medical and health system. Further improve the basic medical insurance system for urban workers and take effective measures to bring mixed ownership, non-public economic organizations and flexible employees into the basic medical insurance for urban workers; Continue to focus on solving the medical security problems of employees and retirees such as state-owned enterprises with difficulties and closed bankrupt enterprises, improve the basic medical insurance system for urban employees, formulate practical measures, and properly handle historical issues while implementing the basic medical insurance system for urban residents; Encourage urban residents of working age who have the ability to work to find jobs in various ways and participate in the basic medical insurance for urban workers; Further standardize the current payment policy of basic medical insurance for urban workers and strengthen the management of medical services. Accelerate the implementation of the new rural cooperative medical system. Further improve the urban and rural medical assistance system. Improve the multi-level medical security system and do a good job in the connection of various medical security systems. Jointly promote the reform of the medical and health system and the drug production and circulation system. In accordance with the overall requirements of deepening the reform of the medical and health system, we should coordinate the reform and system convergence of medical and health care, drug production and circulation and medical security system, and give full play to the role of medical security system in raising medical funds, improving medical quality and controlling medical expenses. Further transform government functions, strengthen regional health planning and improve the medical service system. Establish and improve the health industry standard system, and strengthen the supervision of medical services and drug markets. Standardize medical service behavior, and gradually establish and improve technical standards such as clinical operation norms, clinical diagnosis and treatment guidelines, clinical medication norms, and admission standards. Accelerate the construction of urban community health service system and improve the function of community health service. The qualified community health service institutions will be gradually included in the designated scope of medical insurance; The proportion of medical expenses incurred by insured residents in community health service institutions can be appropriately increased by medical insurance fund. Food and drug supervision departments should vigorously promote the record management, inquiry system and responsibility salesman system of drug sales personnel, and check the qualifications of sales personnel online when purchasing drugs. Establish the credit system and incentive and disciplinary mechanism of medical device production, operation and use units, improve the quality supervision measures of medical institutions, and implement the management measures of medical device purchase and sale invoices and lists. Intransitive verbs strengthen organizational leadership (14) Establish a joint meeting system for urban residents' basic medical insurance departments. The joint meeting is responsible for organizing, coordinating and providing macro guidance, deliberating the implementation plan of the basic medical insurance for urban residents, studying and formulating relevant policies, supervising and inspecting the implementation of policies, summarizing and evaluating the work in a timely manner, coordinating and solving the problems in the pilot work, and submitting reports and suggestions to the overall regional government on major issues. (fifteen) clear responsibilities, strengthen departmental coordination. Establishing the medical insurance system for urban residents is a systematic project involving the whole society. Counties, district governments and relevant departments shall, in accordance with the unified arrangements of the municipal party committee and the municipal government, define the division of responsibilities, cooperate closely, and formulate supporting policies and management measures. The government of the autonomous region is responsible for organizing and coordinating the development of medical insurance for urban residents in this region; The labor and social security department is the competent department of basic medical insurance for urban residents, responsible for organizing the implementation and handling business; The personnel department is responsible for solving the problems of institutions, staffing and personnel of medical insurance for urban residents; The financial department is responsible for the collection and disbursement of government subsidies in the payment of medical insurance for urban residents, and it is included in the annual budget to solve the personnel and business expenses necessary to carry out medical insurance for urban residents. The medical insurance card and card expenses of the insured residents shall be borne by the finance at the same level; The health department is responsible for formulating and implementing preferential policies for medical insurance for urban residents, strengthening the supervision of medical institutions, improving the construction of community health service institutions, and providing basic medical services with high quality and low price for insured residents; The education department is responsible for the registration of students and kindergarten children and the collection and payment of insurance premiums; The public security department is responsible for the household registration of the insured and provides relevant basic data; Civil affairs and the Disabled Persons' Federation departments should do a good job in linking the statistical data of the poor population and the basic medical insurance for urban residents with social medical assistance, coordinate grass-roots community management institutions to publicize the basic medical insurance policy for urban residents, and cooperate with the labor and social security departments to do a good job in the identification, registration and annual examination management of low-income disabled people; Development and Reform Commission, drug supervision and other relevant departments formulate relevant supporting policies and measures, speed up various supporting reforms, and do a good job in medical security for urban residents. It is necessary to mobilize all social forces to create a good environment for promoting the reform of the medical insurance system for urban residents and ensure the smooth progress of this work. (seventeen) to strengthen the propaganda work. Actively carry out various forms of publicity activities, give full play to the role of grassroots community organizations, and make various portable and simple publicity wall charts, brochures, leaflets, etc. , distributed to households by governments at all levels, relevant departments and personnel; Radio, television, newspapers and other news media should strengthen public welfare propaganda, open up special columns, and carry out extensive and lasting publicity in various forms, so as to make the basic medical insurance policy for urban residents a household name, make this policy of benefiting the people deeply rooted in the hearts of the people, gain the understanding and support of the broad masses and all sectors of society, and ensure the smooth implementation of the basic medical insurance for urban residents. (eighteen) to ensure the reasonable convergence of policy treatment. All co-ordination areas should do a good job in policy adjustment and treatment convergence as soon as possible according to this implementation opinion. The county (district) government shall, in accordance with the principle of territorial management and graded responsibility, carefully investigate various unstable factors and resolve contradictions and disputes in a timely manner. Seven. Supplementary provisions (19) Medical expenses incurred due to major epidemics, disasters and emergencies shall be studied and solved by the people's governments in the overall planning areas. (twenty) this opinion is interpreted by the Municipal Labor and Social Security Bureau. (twenty-one) the implementation opinions shall be implemented as of the date of promulgation.