Basic medical insurance for urban residents
1. To establish the basic medical insurance system for urban residents
of the purpose and significance of that?
The establishment of the basic medical insurance system for urban
residents, whose aim is to solve the basic medical insurance for urban
workers is not within the coverage area of the school students,
children and other non-employed urban residents in the basic medical
needs, through co-ordination of economic security for urban residents
and out-patient specific disease kinds of basic health care to reduce
family burden, so that all urban residents Buzhi Yu poverty caused.
The establishment of basic medical insurance system for urban
residents, the health insurance coverage to all urban residents,
towards ensuring basic medical care to protect the goal is to improve
the social security system and improve the livelihood of the people,
building a harmonious community inherent requirement for the majority
of urban residents ease see a doctor an important measure of your
problem, fully embodies the municipal government of the majority of
urban residents in the care and love.
2. Who can participate in the basic medical insurance for urban
(A) Large cities and towns within the city primary and secondary
school students (including vocational high schools, technical
secondary school, students in professional school), not including the
new rural cooperative medical system coverage of rural primary and
secondary school students;
(2) with city urban household, 18 years old and under the non-urban
residents in the school;
(3) with city urban accounts do have special difficulties for
companies not to participate in basic medical insurance for urban
workers and low level of security objects, object edges subsistence
allowances, severe disabilities; collective enterprises in difficulty
did not participate in basic medical insurance for urban residents of
(4) with city urban account of other non-employed urban residents
(including non-employed persons, and to dissolve the labor relations
are not employed, to the Household of landless farmers without jobs,
3. How do urban residents insured?
(1) students to the school unit for the insured, the school organized
the insured; other towns where community residents to account for the
insured unit, the community organized the insured. Fill out the
"insured Registration Form";
(2) management agency review, in order to meet the conditions of the
residents of the insured to establish payment accounts, making health
insurance card, visiting card. School students in basic medical
insurance will pay to the school; other insured residents who pay the
deposit account to the CCB network payment, you can also phone
banking, online banking, self-service terminal payment. A family more
than the insured, you can use the same account;
(3) Medical insurance card and attendance card from the school,
community, took the payment.
4. Insured residents to complete the formalities at what time? What
Processing time: students in the school year on Sept. 15; other urban
residents a month on the 20th.
Bring materials: accounts, identification cards and recently inch
color one photo.
The following people when the insured needs to provide valid proof
(1) minimal needs to bring along an object, "Gold-collar worker,
Benxi City, subsistence evidence";
(2) minimal needs to bring along the edge of the object,
"Gold-collar worker, Benxi City, subsistence evidence";
(3) severe disabilities need to bring "The People's Republic of
China Disabled Persons Permit";
(4) all evidence required original and copy 2 (copy of a community or
school retention, a hand over handling agency).
Five. The insured population in each of fiscal assistance payment
standards and how much?
Project funding criteria categories minimal needs of ordinary
residents of the edge of an object object of severe minimal needs of
persons with disabilities
Personal finance personal finance personal finance personal finance
Payment assistance subsidy payment assistance payment subsidy payment
18 80 4,040,156,515,653,050
Under the non-students
18 to 59 years old 295 255 40 8,521,055,240,170,125
60 years of age 295 195 1,005,524,055,240,125,170
At the same time have the assistance of two or more conditions covered
by the insurance payment, according to the principles of high not to
low-subsidy from the finances, but does not repeat grants.
6. Payment deadlines and payment requirements as to change
What payment limit provisions?
Residents apply for enrollment in the first half, and only pay the
basic medical insurance that year, handled the second half, may
voluntarily choose the year or next year's basic medical insurance;
already have insurance pay residents must pay each year on December 20
The following year the basic medical insurance.
After the interruption of payment, renewal payment processing of the
Annual pre-paid health insurance premiums paid by the residents must
pay a one-time annual basic medical insurance guide. Continuous time
full payment is not considered as interruptions insured, renewal must
be padded arrears during the termination, are in back of the arrears
borne by the individual, do not enjoy government subsidies.
When a change in enrollment status, whether the adjustment of fees?
Insured status is changed, the insured is not the year of payment
standards to be adjusted.
7, how to participate in large health care supplemental insurance?
What is the payment standard?
Basic medical insurance for urban residents, while simultaneously
handling agency to participate in large health care organizations,
supplementary insurance. And basic medical insurance with payment.
Supplementary medical insurance premiums paid by large, the Government
does not give grants. Payment standard: The primary and secondary
school students and 18 schools under the age of non-urban residents in
the 20 yuan per person per year; the other 38 per year per person for
8, after the insured when the residents enjoy the treatment?
Insured residents pay three months from the month after the enrollment
year to enjoy basic medical insurance; students from the enrollment
fee in the year September 1 to August 31 the following year to enjoy
basic medical insurance, which residents participate in Medicare
before admission and continuous payment after graduation or
termination of the insured to change the enrollment status, graduation
year to enjoy the treatment extended to 31 December. During
interruption of the Fund will not pay for medical expenses.
9 What are the benefits of early enrollment?
Residents benefit from early enrollment early, continuous contribution
years for every 1 year, the Fund paid a corresponding increase in the
proportion of 1%, the highest proportion of 70% paid. Residents pay
the end of 2008, from January 1 next year, from basic health insurance
benefits, enjoy the first payment no waiting period.
10, after residents of the insured to see a doctor?
Insured patient clinics, the need to maintain my health insurance card
and attendance cards, free choice of the basic medical insurance for
urban residents designated hospital. Because of loss, emergency and
other reasons, do not carry medical insurance cards and attendance
cards, should be designated hospitals to explain the situation, and
within 3 working days to re-submit, pay up, medical treatment did not
say when the insured status, health insurance card from the show and
attendance card the next day, access to basic medical insurance.
11, medical insurance card, visiting card is lost, damaged to go
through, how to handle referrals?
Insured residents in health insurance card, visiting card is lost or
damaged, can hold his identity or community (schools) that go through
the city IESS Charge of pay.
To turn the principles of sequential referral, the hospital
transferred from the lower parent hospital, the city's hospitals to
provincial hospitals province, the province can not diagnose and
treat, may be transferred to the provincial hospital hospitals outside
the province, reported that the handling agency approval, side can
referral. Transfers be made by attending physicians, patients
themselves or family members agree that the transfer is made after the
views of expert consultation, fill out the "resident medical
insurance referral form for approval," department director to
sign an agreement, approved by the Hospital Medical Insurance
Division, reported record handling agency for approval, before
transfers. Limited to a clinic and effective referral procedures.
Emergency referral when needed, can be transferred first, but it
should be within 3 working days padded procedures.
12, out-patient specific disease include? Pointing out what?
Specific disease patient following eight: 1, cerebral hemorrhage,
cerebral sequelae; 2, cancer, (late); 3, diabetes (with
complications); 4, uremia; 5, TB (activity); 6, mental ; seven, liver,
kidney, bone marrow and other tissue and organ transplantation
postoperative; 8, systemic lupus erythematosus.
Fixed-point out are: Central Hospital, General Hospital of Benxi,
Benxi Iron and north to clinics, municipal Peak Hospital, the Chinese
Medicine Hospital, City Railway Hospital, Benxi Iron and Steel Nanfen
Hospital, Benxi Iron and Steel Waitoushan Hospital, North Hospital
Steel Group employees, Ninth Hospital, Benxi Iron and south to the
hospital, city job Hospital, Jinshan Hospital, Tuen Mun Hospital,
color, Jinshan Hospital shaft City Hospital, Corning Hospital Mental
Branch, Municipal Tuberculosis Hospital (Fifth Hospital), Benxi Iron
and Steel Chest Hospital.
13, How to apply for a special disease doctor-patient procedures?
With specific diseases of the insured patient population, voluntarily
choose a particular disease sentinel clinics, carrying disease-related
information to the clinic to apply for special accreditation disease.
A specified time and place to participate in recognized,
identification of qualified, before they can be fixed out-patient
14, with the insured patient specific disease which are residents of
Outpatient treatment of specific diseases Qifubiaozhun per year 400.
Disease in the special place designated out-patient medical expenses,
in Qifubiaozhun above, the maximum payment limit of the following
section, in school and 18 years of age not in school 60% of urban
residents to be reimbursed by the other 50% reimbursement of the
15, medical expenses to the balance sheet?
Insured residents in the designated hospitals for the Clinic's medical
expenses, pay only the individual pays part of the fund should be part
of the hospital designated by the management agency and direct
billing. Outside the city due to change, emergency and other reasons
in the non-designated medical institutions, clinics, medical expenses
that occurred initially in full advance personal holding referral
procedures, disease Chi copy, medical expenses receipts and expense
details and other relevant information, each month an -15 days to the
management agency for registration, examination and verification by
the handling agency, the fund should be part of the current month on
the 25th to give the required reimbursement.
16, residents pay for health insurance and treatment Qifubiaozhun
City designated hospital
Project Category 1 2 3 3 turn out special disease outside the city
Class A Hospital B Hospital
Qifubiaozhun 200 300,500,500,400,600
Students stay in school and
Case of 18 years of age 65% 65% 70% 60% 60% 60%
Case of the insured 55% 60% 55% 50% 50% 50%
Note: 1, an insured year, several designated hospitals in the city
hospital, Qifubiaozhun in turn reduce the 100, but a minimum of not
less than 100; a natural turn several times during the year outside
the city hospital treatment, from the pay standard not lower.
Outpatient treatment of specific diseases Qifubiaozhun 400 yuan per
year; 2, insured residents pay a row for every 1 year period, fund a
corresponding increase in ratio of 1%, maximum percentage of 70% paid.
3, the Fund paid the maximum annual total of 3 million more than the
maximum limit for part of the medical expenses paid by the required
large medical supplemental insurance to pay.
17, residents in medicine and medical services, medical insurance and
what the requirements?
The scope of health insurance funds to pay the residents, in
accordance with the basic medical insurance requirements of the
pharmaceutical directory, clinics and projects, service areas and pay
the standard and the "basic medical insurance for urban residents
on drug related issues to inform children" (Liao Lao She 
172 No.) regulations.
18, the medical expenses that people will not pay health insurance
One of the following circumstances occurred medical expenses,
residents will not pay for health insurance funds:
(1) in a foreign country or Hong Kong, Macao and Taiwan, treatment;
(2) without the approval of the treatment in non-designated medical
(3) treatment with the content of referral is not genuine;
(4) suicide, self-mutilation (except mental illness);
(5) assault, drunkenness, drug abuse and other crimes because I am due
(6) traffic accident, accidental injury (in school and 18 years of age
not in school than urban residents), medical, etc. who have a clear
(7), miscarriages, fertility, family planning;
(8) Other violations of the provisions of Medicare residents.
19, participants enjoy a large medical supplement insurance, what
Supplementary medical insurance and large medical expenses Peifu ratio
and the basic medical insurance for urban residents to pay medical
expenses the same proportion. Year to pay more than the maximum limit
of the basic medical insurance (3 million) or more of medical expenses
from supplementary insurance as required large medical damages, the
highest maximum incurred as 70,000 yuan, plus the basic medical
insurance, the maximum payment limit, an insured year, can get 10
million maximum health insurance benefits.
20, accidental injury insurance benefits have?
Primary, secondary school students and 18 years of age to participate
in non-urban residents in the large medical school supplementary
insurance, which can enjoy the treatment of accidental injury
insurance, by commercial insurance payment.
(A) the accidental injury suffered in the basic medical insurance for
urban residents designated medical institutions for treatment
occurred, consistent with the scope of the basic medical insurance to
pay medical expenses in accordance with the following provisions
(1) Out-patient medical expenses deduct 50 dollars / percentage is 80%
after deductible to payments to a cumulative maximum of natural
maximum incurred during the year to 3,000 yuan.
(2) hospital expenses deductible for the 100 / second, according to
the following ratio Peifu: 100 yuan to 1,000 yuan, some 50%; 1,000
yuan to 5,000 yuan portion of 60%; 5,000 yuan to 10,000 yuan part 70%;
10,000 yuan to 30,000 yuan more than some 80%; 30,000 yuan or more
parts of 90%. Accidental injury medical expenses accrued in the year
of natural maximum maximum incurred as 100,000 yuan. Due to the
emergency hospital in the city, or out-patient treatment outside the
place of medical expenses in accordance with the above requirements
(B) the accident caused the death, compensation death insurance money
(C) result in death due to diseases of, compensation death insurance
21, which insurance does not cover accidental damage? ?
Accidental injury is being imported, unexpected, unintended, the
objective of non-disease direct result of bodily injury. The following
does not belong to the scope of accident insurance benefits Pei Fu: 1,
subject to a guardian or the beneficiary intentionally kill, injure;
2, suicide, self-mutilation (except mental illness); 3, assault, drink
or use, smoking, injection drug use; 4 drink driving, no valid
driver's license motor vehicle without a valid driving license; 5,
traffic accident, medical malpractice and other medical expenses borne
by the other party liability section; 6, the case of other violations
of policies and regulations.
22, which designated hospitals accidental injury? How to apply for
All urban residents in health insurance, accidental injury insurance
are designated hospitals designated hospitals. Transfer due to
accidental injury hospitalization outside the city, residents need to
apply for the insured, designated medical institutions confirmed that
commercial insurance companies agreed, and relevant procedures.
23, minimal needs an object, the object edge minimal needs residents
to participate in Medicare, the primary treatment is to continue to
enjoy medical assistance? ?
Continue to receive. Participate in the basic medical insurance for
urban residents in urban medical aid target, and enjoy special disease
and hospital out-patient treatment in co-ordination, in the overall
burden of healthcare costs within the individual parts, according to
city policy to give medical aid assistance; in general out-patient
medical costs incurred by, still enjoy former city medical aid
Note: The deficiencies of the Department, by basic medical insurance
for residents of the implementation of the relevant documents; case of
policy changes, the latest implementation of the documents shall