Ji'nan workers' health insurance was implemented last year, the highest level of outpatient service was 2400
Ji'nan times
"basic medical insurance method for Ji'nan workers" (the following simple method) since April 1st this year, October 2002 The Provisional Regulations on the basic medical insurance for urban employees in Ji'nan shall be abolished at the same time. What changes will the new approach bring to the 1 million 830 thousand employees in the city? The relevant people of the Municipal Bureau of human resources and social security have made relevant interpretations.
> [change]
14 yuan a month. The outpatient department of the outpatient service is up to 2400 yuan
the overall fund and personal contribution, among which the personal contributions are raised by 10 yuan per person per person per month, and the standard of the large amount of medical expenses is raised from 4 yuan to 8 yuan per month.
in general, the insured person to the outpatient cost of medical insurance card will be able to achieve immediate settlement, but only one designated medical institution can be selected in a medical year. The cost below the starting and paying standard is paid by the individual.
at present, the insured person who has enjoyed the treatment of medical insurance is in accordance with the principle of participating in the month of insurance. In April, it began to pay the fund of the general outpatient service, and began to choose the designated medical institutions in the late 4 months, and enjoy the related treatment from May 1st. The time for choosing a designated medical institution is further informed.
[change two]
cancellations of
the old old methods of the old man
the relevant people of the city Bureau introduced the cancellation of the 12 types of disease species that are relatively low, can be cured and can basically meet the needs of the outpatient service, and retain the rest of the 23 diseases. For the abolition of the 12 diseases, the old methods of the elderly, the implementation of the measures have been passed before the identification of the insured, the treatment is not changed for the time being in April 1st no longer accept the new identification application of the 12 diseases, the insured can be treated in accordance with the policy of general out-patient co-ordination.
cancelling disease type
chorea, chronic bronchitis, hyperthyroidism, gout, osteoarthritis (hand, hip, knee osteoarthritis), atrophy of the brain, hypothyroidism (primary), lithiasis (urinary, digestive system), digestive system disease (superficial gastritis, atrophic gastritis, gastric ulcer)
[change three]
retirement account gold supercapping line maintained original
regulations, the retirees' personal account gold in accordance with the basic pension (retirement pension) of 4% of the monthly pensioners.
the maximum amount of the insured ceiling refers to the standard after deducting 10 yuan outpatient funds and 8 yuan large medical subsidy. The insured person who has already enjoyed the basic medical insurance treatment of the retirees before the implementation of the method is higher than the cap of the corresponding age section of the individual account. At present, the amount of the original account is kept unchanged.
monthly account amount 50 yuan.Amp; mdash170 yuan
60 years old and above 70 years old,
monthly account amount 60 yuan.Amp; mdash190 yuan
70 years of age 80 years old / >
monthly account amount 70 yuan.Amp; 80 yuan / > 80 years old. 90 years of age under the age of 90 years
monthly account amount 80 yuan.Amp; mdash220 yuan
90 years old,
monthly account amount 90 yuan.Amp; mdash220 yuan
maximum payment limit from 290 thousand yuan / > to 440 thousand yuan
maximum payment limit, generally speaking, it is often said by the common people The capping line that is paid by the fund is not to say how much it is spent. The medical expenses above the maximum limit of payment are not within the scope of the payment of the medical insurance fund. The maximum limit of payment for hospitalized and out-patient services increased from 4 times the average wage of the employed workers in the previous year to 6 times. To this end, the Municipal Bureau of people's society also issued the "announcement about the maximum payment limit of the basic medical insurance fund for staff and workers", which determined that the maximum payment limit for medical insurance for workers in Ji'nan has reached 440 thousand yuan since April 1, 2014.
maximum limit of
adjustment, the maximum payment limit is 290 thousand yuan
adjustment, the maximum payment limit is 440 thousand yuan
the maximum payment limit of medical insurance fund in hospital and outpatient medical insurance fund is raised from 90 thousand yuan to 240 thousand yuan large salvage deposit 200 thousand
[change five]
medical insurance year changed from original April to January
medical insurance year is from April 1st each year to March 31st of next year. In this way, the annual medical insurance will be adjusted from January 1st to December 31st every year, consistent with the natural year and the fiscal year. This adjustment means that the 2014 medical insurance year is only 9 months left (only 8 months for the period of the overall treatment of the outpatient service). In order to ensure the medical treatment of the insured, the outpatient regulations, the out-patient service standards and the maximum payment limit will be adjusted in proportion on a temporary basis (see table), and the full standard will be restored in the next year.
that is to say, there will be a "special" starting line this year. For example, the standard of outpatient Co ordinating payment in designated community health service institutions is 400 yuan in normal year, and this year it will be reduced to 266 yuan.
[change six]
part of the insured person may be able to settle the real time settlement and fraud by a penalty of 2 to 5 times the amount of the amount of the amount of the amount to be deceived
regulations, the outpatient service and the general outpatient medical expenses of the general outpatient service shall be provided by the outpatient staff and the retirees in other places. Effective expense documents and expense lists are reimbursed to social insurance agencies. In the foreign medical institutions, the long stationed in the field and the other places are in the medical institutions of other places. The selected medical institutions belong to the immediate settlement medical institution of the alien network. The insured should put on record to the social insurance agency when the insured person is in hospital, and the medical expenses will be settled immediately when discharged from the hospital.
the insured person who is temporarily in the field of emergency treatment in the field can only reimburse the medical expenses of one of the medical institutions, such as the medical bills of a number of medical institutions, which must be accompanied by corresponding referral certificates. The
method has made a clear definition of violations, and the penalties have been further intensified. For employers or individuals, there are 7 kinds of behaviors which are expressly prohibited. For example, the administrative department of social insurance is ordered to return the basic medical insurance fund for fraud by the administrative department of social insurance and is fined less than five times more than two times the amount of the amount of fraud.
special reminder
flexible employment personnel need to deposit more than 14 yuan