Our city plans to introduce basic medical insurance and maternity insurance methods for employees of the Special Economic Zone

In order to improve the basic medical insurance and maternity insurance system of employees, ensure the basic medical needs of employees, safeguard the legitimate rights and interests of employees, and promote social harmony, combined with the actual situation of Shantou Economic Zone, our city plans to formulate and introduce the "Shanetou Economic Special Economic Zone Workers' Basic Medical Insurance and Maternity Insurance Measures" At present, the draft for soliciting comments has been formed and comments from all walks of life.

Soliciting comments draft proposes that the combination of basic medical insurance and maternity insurance (hereinafter referred to as employees' basic medical (maternity) insurance) is merged and implemented. The basic medical (maternity) insurance work in the SAR is applicable to these measures. The employer shall pay the basic medical (maternity) insurance premiums in full on time, and individual employees shall pay the basic medical insurance premiums of the employee on time and do not pay the maternity insurance premiums. The basic medical insurance premiums paid by employees shall be deducted by the employee in the middle of the employee's salary. Basic medical insurance for employees is divided into two types of insurance two insurance types: unified accounts combined with employee medical insurance and single construction overall staff medical insurance. The same employer can only participate in a type of insurance in the unified ledger and the employee's medical insurance or the single construction of a coordinated employee medical insurance.

Mutual recognition of the insurance payment period of all coordinating areas

The draft for the comments proposed that the insured person who reaches the legal retirement age, the cumulative payment period of the basic medical insurance of the employee reaches the following provisions, and the actual payment of the actual payment of the special zone for 10 years, the payment will be stopped from the next month and continues to enjoy the employees. Basic medical (fertility) insurance benefits: Personnel retired before December 31, 2022, with a cumulative annual payment of 20 years; those who retire in 2023, male employees have accumulated a total of 21 years, and female employees have accumulated annual payment for 20 years; 2024 2024; 2024 For those who retired in the year, the accumulated payment of male employees for a total of 22 years, and female employees have accumulated a total of 20 years; those who retired in 2025, the accumulated payment of male employees for a total of 23 years, the accumulated annual payment of female employees for 20 years; retirement in 2026 retirement in 2026; retirement in 2026 retirement in 2026 The personnel, the accumulated payment of male employees for a total of 24 years, and female employees have accumulated a total of 21 years; those who retired in 2027, the cumulative payment of the male employees for a total of 25 years, the accumulated payment of female employees for a total of 22 years; the retired personnel who retired in 2028 , Male employees have accumulated a total of 26 years, and female employees have accumulated a total of 23 years; those who retired in 2029, male employees have accumulated a total of 28 years, female employees have accumulated annual limit for 24 years; from January 1, 2030 With retired personnel, male employees have accumulated a total of 30 years, and female employees have paid a total of 25 years. When the insured person handles retirement (including early retirement in compliance), if he is dissatisfied with the payment period specified in the previous paragraph, the employer or himself before retirement can continue to pay to the prescribed period, stop paying and continue to enjoy the basic medical care of the employee (fertility) Insurance treatment. The insured persons are recognized by the payment period of the basic medical insurance for employees in various overall regions, and the consolidated calculation is the cumulative payment period. The annual service of soldiers restrictions on the actual payment of basic medical insurance for employees, and the calculation of the payment period of the payment of basic medical insurance for the basic medical insurance before the enlistment and exit. According to the draft for comments, when the insured person reaches the legal retirement age, if the basic medical insurance payment of the employee does not reach the prescribed period of continued inspection, the maternity insurance premium will not be paid. The period, based on the average monthly salary of the full -caliber monthly monthly monthly monthly monthly salary of the city, and participating in the unified account and the medical insurance of the employee, the payment ratio is 6%; if it participates in the single construction overall staff medical insurance, the payment ratio is 5%.

Overdue reimbursement medical security agencies will not be accepted

Soliciting comments draft proposes that the basic medical insurance for employees shall implement designated medical institutions and designated retail pharmacies. The medical security agency is responsible for determining the designated medical institutions and fixed -point retail pharmacies, and undertakes specific work such as application acceptance, admission assessment, negotiation and signing, expense settlement, and agreement management of designated medical institutions and fixed -point retail pharmacies. Participants can seek medical treatment and purchase of medicines at designated medical institutions, or they can also buy medicines at fixed -point retail pharmacies with prescriptions. Insured persons who purchase medicines for medical treatment, purchase medicines or purchase medicines at fixed -point retail pharmacies at fixed -point medical institutions belong to the scope of the employee basic medical insurance fund, and will account for accounting by fixed -point medical institutions and fixed -point retail pharmacies in accordance with regulations, and then medical security with medical security. Settlement of agencies; those who belong to the scope of personal account payment, shall be settled by fixed -point medical institutions and fixed -point retail pharmacies in accordance with regulations. The medical expenses incurred by the insured person for medical treatment are paid by the employee's basic medical insurance fund, and the designated medical institutions will account for bookkeeping and settle with the medical security agency in accordance with the prescribed regulations. If it belongs to the scope of personal account payment, it can be paid by a personal account according to regulations. If you cannot pay the accounts under special circumstances, the insured persons will be paid first and then will be reimbursed at the medical security agency. Insured persons should go to the medical security agency within 12 months from the date of discharge. Among them, the reimbursement of maternity medical expenses shall be within 3 years from the next day of delivery, termination of pregnancy, or implementing family planning surgery. The organization does not accept it.

Insurance personnel are hospitalized for medical treatment, there are settings

Soliciting comments draft proposes that the standard settings of the insured persons are as follows: 1,000 yuan for third -level medical institutions in medical institutions in the SAR, 400 yuan for secondary medical institutions, and first -level medical institutions (including unscrupulous medical institutions) 200 yuan Essence A medical institution outside the SAR 1,000 yuan. In addition, the special situation of the starting payment standard is: each time the insured person is hospitalized, the medical expenses below the payment standard are paid by the individual. In special circumstances, the following measures are processed: a malignant tumor, mental illness, and healing friends within the year of a medical insurance settlement year If the disease or regenerative disorders are hospitalized in the special zone designated medical institution, they only need to pay the following expenses at the time of the first hospitalization; If you transfer to the hospital for the starting payment standard than the transfer of the hospital, the cost of the difference shall be paid. The basic medical expenses of the offering of insured persons in accordance with the upper payment standards shall be paid by employee basic medical insurance funds in proportion. The medical insurance fund that should be borne by a third party shall not pay

Soliciting comments draft proposes that within a year of medical insurance settlement, the maximum payment limit for the outpatient disease and hospitalization benefits of the basic medical insurance fund of employees and the inpatient treatment is determined according to the time of continuous insurance payment: the continuous insurance payment time is 12 months in 12 months In the following, the cumulative maximum payment limit of the year is 100,000 yuan; if the continuous insurance payment time is more than 12 months, the cumulative maximum payment limit of the year is 400,000 yuan. The employee's basic medical insurance fund pays the general outpatient clinic for overall treatment and maternity insurance benefits are not included in the highest payment limit of the year's basic medical insurance. In the following seven situations, the basic medical insurance fund of the employee shall not pay: those who should be paid from the work injury insurance fund; shall be borne by a third person; shall be borne by public health; seek medical treatment abroad; sports, fitness, health care and health care Consumption and health checkups; insured persons who need to seek medical treatment at non -fixed medical institutions due to emergency or rescue; the basic medical insurance funds stipulated by the state will not pay other expenses.

(Source: Shantou Daily)

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