The administrative offices of the Union, the Municipal People’s Government, the commissions, offices, departments and bureaus of the autonomous region, and major enterprises and institutions:
With the consent of the people’s government of the Autonomous Region, the Measures for the Administration of Basic Medical Insurance for Employees of Inner Mongolia Autonomous Region, the Measures for the Administration of Large Medical Insurance for Employees of Inner Mongolia Autonomous Region, the Measures for the Settlement of Basic Medical Insurance Expenses for Employees of Inner Mongolia Autonomous Region, the Measures for the Administration of Referral and Transfer of Basic Medical Insurance for Employees of Inner Mongolia Autonomous Region and the Measures for the Administration of Personal Accounts and Social Security Cards for Employees of Inner Mongolia Autonomous Region are hereby printed and distributed to you, please follow them carefully.
Measures for the administration of basic medical insurance for employees at the same level in Inner Mongolia Autonomous Region
chapter one??total??rule
????the first??In order to promote the reform of the basic medical insurance system for urban workers in our district and ensure the basic medical care for employees, according to the decision of the State Council on establishing the basic medical insurance system for urban workers (Guo Fa [1998〕forty-fourNo.), "People’s Republic of China (PRC) Social Insurance Law" and "Implementation Opinions of the People’s Government of Inner Mongolia Autonomous Region on Establishing the Basic Medical Insurance System for Urban Workers" (Internal Affairs [1999〕74No) and the relevant laws and regulations of the state and the autonomous region, these measures are formulated.
the second??Directly under the authority, institutions in the autonomous region, the central directly under the authority in Hohhot and the autonomous region management institutions and their employees directly under the central government should participate in the basic medical insurance for employees at the autonomous region level in accordance with these measures.
Article??The administrative department of medical insurance in the autonomous region shall administer the basic medical insurance for urban workers, uniformly lead and organize the work of basic medical insurance for employees at the corresponding level in the autonomous region, and supervise and inspect the income and expenditure of the medical insurance fund. Its main functions are:
(a) to implement the relevant policies of the state and the autonomous region on medical insurance for urban workers.
(two) in conjunction with the relevant departments to formulate and improve the relevant policies and systems of medical insurance for urban workers in the autonomous region.
(three) to declare the designated medical institutions and retail pharmacies for qualification examination.
(four) the implementation of administrative management and supervision of the basic medical insurance agencies.
(five) to supervise and inspect the implementation of the basic medical insurance policies, and investigate and deal with all kinds of violations of the relevant provisions of the basic medical insurance.
(six) to coordinate the relationship between various departments in the implementation of basic medical insurance.
Article 4??The Medical Insurance Administration of the Autonomous Region (hereinafter referred to as the Medical Insurance Bureau) has the approval of the organization committee of the autonomous region.2013〕43Number) functions and responsibilities.
Article 5??The financial department of the autonomous region should strengthen the supervision and management of the basic medical insurance fund; Audit departments should regularly audit the income and expenditure and management of medical insurance funds; The health administrative departments and drug supervision departments of the autonomous region should strengthen the administration of designated medical institutions and retail pharmacies, and actively promote the reform of the medical and health system; The local tax collection sub-bureau directly under the autonomous region is responsible for the collection and payment of medical insurance premiums at the same level in the autonomous region.
Article 6??The people’s Government of the Autonomous Region shall set up a basic medical insurance fund supervision organization with the participation of representatives of relevant government departments, insured units, medical institutions, trade union representatives and relevant experts to supervise the collection, management and use of medical insurance funds.
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chapter two????Raising the basic medical insurance fund
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Article 7??The basic medical insurance premium is jointly paid by the insured unit and the insured individual. The payment base is approved once a year in June, and will not be adjusted during the year. The payment standard is:
(a) the insured units above the annual total wages of employees as the base, according to7%Pay.
(two) the insured individual above the annual wage income as the base, according to2%Pay.
(three) the payment rate of flexible employees is the sum of the payment rates of the insured units and individuals.
(4) Retirement of the insured:
Unit insured:
The insured meets the statutory retirement conditions, and at the same time meet the following conditions, enjoy the medical insurance benefits for retirees:
1.2005yearsixmoon30sunThose who participated in medical insurance before can change directly when they go through the medical retirement procedures, and no longer calculate the payment period.
2.2005yearsevenmoononesunAfter participating in medical insurance, the actual payment period is insufficient when handling medical retirement procedures.twentyIn 2000, the basic medical insurance premium for the difference in the actual payment months shall be paid by the employing unit at one time according to the monthly salary at the time of retirement and the payment ratio of the basic medical insurance unit in that year, and all the expenses shall be included in the overall fund without personal account.
Flexible employees:
Flexible employees meet the statutory retirement conditions, and at the same time meet the following conditions, enjoy medical insurance benefits for retirees:
1.Medical insurance payment period expires.twentyYears. The actual payment period is insufficienttwentyYears, with reference to the unit insured one-time payment method to repay.
2.Flexible employment, also can not handle medical retirement procedures, extend the payment to full.twentyGo through the formalities of medical insurance retirement after the year.
(five) the average wage of employees in the insured unit last year was lower than the average wage of the society in Hohhot last year.80%At an average wage.80%Is the base of payment; Higher than the average salary in Hohhot last year.300%Above, with300%Is the payment base.
The payment base of flexible employees is based on the average social wage in Hohhot last year.80% approved.
With the development of economy, the premium rate of basic medical insurance will be adjusted by the people’s government of the autonomous region.
Article 8 On the basis of participating in basic medical insurance, the employer may establish supplementary medical insurance for employees. Supplementary medical insurance premiums in total wages4%Within the part, from the employee welfare funds charged, welfare funds insufficient charged part, approved by the financial sector included in the cost. The supplementary medical insurance fund shall be managed by the employer itself.
Article 9??The basic medical insurance premium shall be paid on a monthly basis, or paid in advance on a quarterly or annual basis. Insured units must be paid in full within the prescribed time limit. The part paid by individual employees shall be withheld by the employer from the salary.
Article 10??Insured units shall, in accordance with the relevant provisions of the Social Insurance Law, handle the registration and declaration procedures of basic medical insurance in a timely manner. When the registered items of the insured unit are changed or terminated according to law, it shall be from the date of change or termination.30Go to the medical insurance bureau for change or cancellation of registration within days.
Article 11??If the insured unit is merged, divided or transformed, the receiving or inheriting unit must go through the relevant change procedures at the Medical Insurance Bureau in time and pay off the unpaid basic medical insurance premium, interest and overdue fine. According to the provisions of the "Social Insurance Law", from the date of default, a late payment fee of 0.5% shall be added daily. Late fees are incorporated into the medical insurance fund. The late payment fee shall be paid by the receiving unit or the inheriting unit.
Article 12??The insured shall pay the medical insurance premium due to job transfer, death and termination of labor relations with the employer, and30Go to the medical insurance bureau for conversion, storage and cancellation within days. All the medical expenses incurred if they are not handled on time shall be borne by the original unit.
Article 13??The basic medical insurance premium cannot be reduced, and no unit or individual may refuse to pay or underpay for any reason.
chapter three????Establishment of basic medical insurance pooling fund and individual account
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第十四条??The basic medical insurance combines social pooling with individual accounts. The basic medical insurance premiums paid by the insured are all included in the personal account; The basic medical insurance premium paid by the insured unit is divided into two parts, one part is used to establish the overall fund, and the other part is included in the personal account.
第十五条??The basic medical insurance premium paid by the insured unit is included in the personal account, which is determined according to different age groups. Based on my salary income in the previous year, my age is at45Under the age of (including45Years old) workers, according to1?Zan1%The proportion is included in the personal account; Age at45Workers aged over to retirement, according to1?Zan3%The proportion of personal accounts; Retirees according to the total pension3?Zan5%The proportion of personal accounts. Adjust the allocation ratio in a timely manner with the operation of the fund.
The full-time age of employees shall be determined according to the age recognized by the relevant departments.
第十六条??The employees transferred to and from the employing units listed in Article 2 shall go through the relevant procedures for personal accounts in time.
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chapter four??Payment of basic medical insurance fund
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第十七条??The basic medical insurance fund and individual account should be divided into their respective payment ranges, and managed separately and accounted for separately according to the principle of fixed income and expenditure, balance of payments and slight savings, and shall not be mutually occupied.
第十八条??Personal accounts are mainly used for payment:
(1) Medical expenses and medicine expenses within the scope of the relevant policies and regulations that are met in the outpatient service of designated medical institutions and the purchase of medicines in designated retail pharmacies.
(two) the overall fund Qifubiaozhun below the medical expenses.
(three) medical expenses paid by individuals above the minimum threshold and below the maximum payment limit. The part of the personal account that is insufficient to pay shall be paid by myself.
Article 19??The overall fund is mainly used to pay the medical expenses for hospitalization, emergency rescue, approved special chronic diseases and outpatient special examination and treatment of insured patients.
Beyond the scope of the basic medical insurance in the autonomous region, the scope of medical treatment projects and medical service facilities, the overall fund will not pay.
Article 20??The insured is hospitalized for the first time or given emergency treatment in a designated medical institution within one year, and the minimum payment standard of the overall fund is: the third-class first-class hospital is600Yuan; Class III B hospitals arefour hundredYuan; The second-class and below hospitals are300Yuan. For those who have been hospitalized for many times within one year, the Qifubiaozhun for the second hospitalization will be reduced in turn on the basis of the Qifubiaozhun for the first hospitalization.20%, but the minimum number of hospitals with Grade III A, Grade III B, Grade II A and below shall not be less thanfour hundred、300、200Yuan.
The maximum amount of medical expenses that can be paid by the overall fund within one year is20?ZanfiveTen thousand yuan.
Article 21??The part above the Qifubiaozhun of the overall fund and below the maximum payment limit shall be paid by the overall fund and the insured in proportion according to the method of "subsection calculation and cumulative payment".
(a) the proportion of the insured person’s overall fund payment is as follows:
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(two) the medical expenses above the maximum payment limit shall be solved by establishing large medical insurance.
(three) the basic medical insurance fund Qifubiaozhun, payment ratio, maximum payment limit in the future with the average annual salary of workers and medical consumption level changes to make corresponding adjustments.
(four) the following medical expenses are not included in the payment scope of the basic medical insurance fund:
1.Should be paid from the industrial injury insurance fund;
2.Should be borne by a third party;
3.Should be borne by public health;
4.Going abroad for medical treatment.
Medical expenses shall be borne by the third party according to law. If the third party fails to pay or cannot determine the third party, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund has paid in advance, it has the right to recover from the third party.
Article 22??Designated hospitals with the qualification of transferring from outside the region are indeed limited by technical and equipment conditions, and difficult and severe patients with unknown diagnosis or difficulties in treatment need to be transferred to outside the region (Beijing, Tianjin and Shanghai) for diagnosis and treatment. The hospital shall put forward the opinion of transferring, and can be transferred only after being approved by the Medical Insurance Bureau. The transferred hospital must be a local medical insurance designated hospital, and the proportion of hospitalization medical expenses paid by the overall fund shall be reduced on the basis of Article 21.5%.
Article 23??During the hospitalization of the insured, the expenses of using class B drugs and basic medical insurance to pay part of the expenses for the diagnosis and treatment projects, and the expenses of using blood products and protein products according to the doctor’s advice during the rescue and first aid are paid by myself first.10%The rest is paid by the overall funds and individuals according to the prescribed proportion.
Article 24??Retirees who have lived and resettled in different places for a long time and the insured who need to go abroad for more than one year because of their work need to go to other places for medical treatment. I choose three local designated medical institutions for basic medical insurance and a designated retail pharmacy to buy medicines, and the unit where I work will issue a certificate and put it on record after approval by the Medical Insurance Bureau. The medical expenses incurred shall be paid in advance by myself first, and after the medical treatment, the medical insurance bureau shall handle the reimbursement procedures with valid vouchers.
Article 25??The insured suffers from sudden illness during business trip or visiting relatives outside the district, and is filed in the Medical Insurance Bureau (sixWithin working days), the medical expenses incurred shall be submitted to the medical insurance bureau for reimbursement with valid documents, medical certificates and proof from the employer. The reimbursement standard for hospitalization medical expenses is reduced on the basis of Article 21 of these Measures.5%. In the area of business trips, visiting relatives with sudden illness of the insured, the medical expenses in accordance with the provisions of article twenty-first of the reimbursement ratio.
Article 26??The insured unit or the insured person owes the basic medical insurance premium, and the medical expenses incurred from the next month will be suspended from the overall fund, and the reimbursement procedures will be handled by the medical insurance bureau with the relevant documents after the arrears are paid; Interrupt time exceedssixFor months or more, the medical expenses incurred during the interruption period will not be reimbursed.
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chapter five??Management of basic medical insurance fund and medical service
Article 27??The basic medical insurance fund shall be managed by the Medical Insurance Bureau in a unified way, incorporated into the financial accounts at the same level, managed by two lines of revenue and expenditure, and used for special purposes. No unit or individual may misappropriate it, nor can it be used to balance the financial budget, nor may it extract funds from the agencies. The medical insurance bureau should establish and improve the basic medical insurance budget and final accounts system, financial accounting system and internal audit system, and strengthen the management of the basic medical insurance fund.
Article 28??Bank interest-bearing measures for basic medical insurance funds: the basic medical insurance funds raised in that year bear interest according to the interest of current deposits; Last year’s fund principal and interest, according tothreeOne-month lump-sum deposit and lump-sum withdrawal of bank deposit interest rate; Deposited funds in financial accounts, mutatis mutandis.threeThe annual lump-sum savings deposit interest rate is not lower than the interest rate of this grade.
Article 29??The principal and interest of the personal account of the insured are owned by the individual, which can be used and inherited according to law.
Article 30??The insured person has the right to supervise the operation of the basic medical insurance fund, and also has the right to inquire about the income and expenditure of his personal account with the employer and the medical insurance bureau.
Article 31??The basic medical insurance for employees at the autonomous region level shall be managed by designated medical institutions and retail pharmacies. Insured persons can voluntarily choose any designated medical institutions and retail pharmacies in Hohhot for medical treatment and drug purchase.
Article 32??The medical insurance bureau adopts the mode of medical service agreement management for the management of designated medical institutions and retail pharmacies. Designated medical institutions and retail pharmacies should conscientiously fulfill the medical service agreement and related medical insurance policies, and it is strictly forbidden to take an impostor for hospitalization, hang up the bed for hospitalization, decompose hospitalization and other phenomena, and it is strictly forbidden to sell counterfeit drugs and inferior drugs, swap drugs and exchange cash.
Article 33??The management of special chronic diseases in outpatient department adopts the system of regular examination and approval.
If uremia is treated with hemodialysis, anti-rejection immunomodulatory drugs after organ transplantation, cancer radiotherapy and chemotherapy, cancer non-radiotherapy and chemotherapy, coronary heart disease (after installing pacemaker, placing vascular stent and bypass surgery) and tuberculosis, it will be approved once a month.
Diabetes mellitus complicated with serious complications (i.e., fundus hemorrhage or exudation, cerebrovascular disease, peripheral neuritis and skin infection), stage III hypertension (i.e., blood pressure reaches the level of diagnosed hypertension, Combined with cerebrovascular accident or hypertensive encephalopathy, left heart failure, renal failure, fundus hemorrhage or exudation), cerebral hemorrhage and cerebral infarction recovery period (muscle strength is below grade 3), liver cirrhosis with severe diseases in decompensated stage, systemic lupus erythematosus, Parkinson’s disease, psychosis, chronic renal failure in azotemia stage and uremia stage, rheumatoid arthritis, aplastic anemia, myeloproliferative diseases, scleroderma, psoriasis, viral hepatitis B and C (normal liver function)
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Chapter vi??Treatment of relevant personnel
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Article 34??National civil servants participate in basic medical insurance and enjoy Medicaid policy. If there is a balance in the civil service subsidy fund, it can cooperate with commercial insurance to pay for the self-paid part of the medical expenses of the insured.
Article 35??Administrative institutions triage personnel leave to participate in study and training, and still participate in the basic medical insurance of the original unit. Personnel who are diverted to enterprises and institutions shall participate in the basic medical insurance of their units. Whether the resigned person participates in the basic medical insurance or not, based on the principle of voluntariness, all the basic medical insurance premiums shall be paid by himself.
Article 36??Provincial cadres, retired personnel, the old Red Army and all disabled persons disabled during the Cultural Revolution do not participate in the basic medical insurance, the relevant treatment remains unchanged, and the medical expenses are solved according to the original funding channels.
Retired people with basic disabilities during the Cultural Revolution participate in basic medical insurance and take proper care of them, which is reduced on the basis of qifubiaozhun for retirees.10%; The establishment of personal accounts shall be carried out according to the method of retirees, and the self-payment ratio shall be reduced by two percentage points on the basis of the retirement self-payment ratio. On-the-job people with basic disabilities in the Cultural Revolution are implemented according to the standards of retirees.
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Chapter VII??attach??rule
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Article 37??本办法自发布之日起实行。
The original Interim Measures of Inner Mongolia Autonomous Region for Basic Medical Insurance for Employees at the corresponding level shall be abolished at the same time.
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Measures for the administration of large medical insurance for employees at the same level in Inner Mongolia Autonomous Region
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the first??In order to solve the medical expenses beyond the maximum payment limit of basic medical insurance for employees at the corresponding level in the autonomous region due to illness, these measures are formulated in accordance with the Measures for the Administration of Basic Medical Insurance for employees at the corresponding level in Inner Mongolia Autonomous Region.
the second??Large medical insurance for employees at the same level in Inner Mongolia Autonomous Region shall be organized and implemented by the Medical Insurance Administration of the Autonomous Region (hereinafter referred to as the Medical Insurance Bureau) under the unified leadership of the Human Resources and Social Security Department of the Autonomous Region.
Article??All units and employees who participate in the basic medical insurance for employees at the autonomous region level must participate in large medical insurance.
Article 4??The maximum payment limit of large medical insurance fund within one year is10Ten thousand yuan.
Article 5??Large medical insurance funds are raised according to the principle of fixed income and expenditure and balance of payments. The payment standard is the insured person per person per year.100Yuan (including retired employees) shall be paid by the employer, and the termination of labor relations and flexible employment shall be paid by individuals.
Article 6??Large medical insurance premiums shall be paid annually and paid in full before the end of January each year. The large medical insurance premium of the new insured shall be paid in full by the unit at the time of insurance.
Article 7??Personal accounts are not established for large medical insurance premiums, and all large medical insurance premiums paid by employers are used to establish large supplementary funds. Large medical insurance premiums cannot be reduced or exempted, and no unit may refuse to pay or underpay for any reason.
The employer fails to pay large medical insurance premiums in accordance with the regulations and suspends the enjoyment of large medical insurance benefits.
Article 8??If the insured person flows within the overall planning scope of the autonomous region, the large medical insurance relationship will be transferred with it; If the insured person is transferred from the overall scope of the autonomous region at the same level, the relationship and treatment of large medical insurance will be terminated from the date of transfer.
Article 9??The insured in the designated medical institutions in line with the "three directories" within the large medical expenses, large medical insurance fund payment ratio isninety-seven percent, the proportion of payment for referral is92%.
Article 10??Insured persons use Class B drugs according to the doctor’s advice and pay part of the expenses with basic medical insurance during hospitalization in designated medical institutions; If blood products or protein products are used during rescue and first aid, the expenses shall be borne by myself.10%, large medical insurance fund payment90%; The expenses incurred in transferring to a hospital outside the district shall be paid by myself.15%, large medical insurance fund payment85%.
Article 11??The large medical insurance fund and the basic medical insurance fund shall be operated separately, accounted for separately, and used for special purposes, and shall not be misappropriated or misappropriated.
Article 12??If there is a balance in the large medical insurance fund, it can cooperate with commercial insurance to pay the self-paid part of the medical expenses of the insured.
Article 13??本办法自发布之日起实行。
The original Interim Measures of Inner Mongolia Autonomous Region for Large Medical Insurance for Employees at the corresponding level shall be abolished at the same time.
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Measures for the settlement of basic medical insurance expenses for employees at the same level in Inner Mongolia Autonomous Region
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the first??In order to strengthen the settlement management of basic medical insurance expenses for employees at the corresponding level in the autonomous region, these measures are formulated in accordance with the Measures for the Administration of Basic Medical Insurance for Employees at the Corresponding Level in Inner Mongolia Autonomous Region (hereinafter referred to as the Measures).
the second??The expenses that should be borne by the insured person for medical treatment in the outpatient department of the designated medical institution or for drug purchase in the designated retail pharmacy and hospitalization in the designated medical institution shall be settled by himself and the medical institution and retail pharmacy. When using personal account funds, use social security card to settle accounts, and the insufficient part will be paid by myself in cash.
Article??The basic medical insurance personal account fund paid by the insured workers at the autonomous region level in designated medical institutions and retail pharmacies, and the medical insurance administration of the autonomous region (hereinafter referred to as the medical insurance bureau) shall settle with the designated medical institutions and retail pharmacies on a monthly basis.
(1) Settlement method: Designated medical institutions and retail pharmacies should open individual account fund settlement accounts for basic medical insurance in financial institutions, and report the name and account number of the opening bank to the Medical Insurance Bureau for the record, and the Medical Insurance Bureau will carry out transfer settlement.
(two) settlement procedures: designated medical institutions and retail pharmacies need to settle accounts every day, and the next month after the end of the month.onetill/extremelyfiveDay (holidays postponed) will be last month’s basic medical insurance personal account card monthly statement and settlement invoice submitted to the medical insurance bureau, at the same time, the consumption details, daily statement, prescription and other information will be properly kept for future reference.
The fund management department of the Medical Insurance Bureau shall review the materials submitted by the designated medical institutions and retail pharmacies every month. After the review is correct, the basic medical insurance personal account fund shall be settled with the two institutions.
Article 4??The medical expenses incurred by the insured in hospitalization paid by the overall fund shall be settled by various payment methods under "total prepayment".
The Medical Insurance Bureau distinguishes the designated medical institutions at different levels, refers to the average medical expenses per hospitalization in previous years or quarters, eliminates unreasonable factors, and reasonably formulates the total index and the average quota management standard per hospitalization. The quota standard shall be adjusted accordingly with the change of the raising ratio of the basic medical insurance fund.
Article 5??The quota standard of hospitalization medical expenses in designated medical institutions can fluctuate up and down.10%The actual expenses incurred by designated medical institutions exceed the quota standard.10%-15%Between, designated medical institutions and medical insurance bureau each bear the excessive part.50%; Exceed the quota standard15%All the above parts shall be borne by designated medical institutions.
The actual expenses incurred by designated medical institutions are lower than the quota standard.10%-15%Between the balance of expenses, the balance of the part.50%Award to designated medical institutions; The actual cost is lower than the quota standard.15%The following, the medical insurance bureau according to the actual medical expenses settlement.
Designated medical institutions that implement "total amount control", the actual expenses incurred are lower than the annual total amount control standard, and all the remaining expenses belong to designated medical institutions.
Designated medical institutions will report the detailed monthly report of the discharge expenses of insured patients to the medical insurance bureau every month, and the medical insurance bureau will pay the expenses first after passing the examination.90%.
Article 6??During the hospitalization of the insured, the medical treatment project that uses the basic medical insurance to pay part of the expenses according to the doctor’s advice shall be approved by the medical insurance department of the designated medical institution, and the expenses shall be paid by myself first.10%, the rest90%By pooling funds and individuals in accordance with the provisions of the proportion of payment; According to the doctor’s advice, I will pay for the use of Class B drugs listed in the Catalogue of Basic Medical Insurance Drugs in Inner Mongolia Autonomous Region.10%, the rest90%By pooling funds and individuals in accordance with the provisions of the proportion of payment.
Article 7??Insured outpatient medical treatment due to illness need special treatment, must be approved by the medical insurance bureau, Qifubiaozhun (300Yuan) above, the expenses below the maximum payment limit shall be paid by the overall fund and individual according to the prescribed proportion.
Article 8??If the critically ill insured person uses blood products and protein products according to the doctor’s advice during the first aid and rescue, he can use them first, andfiveWithin days, I will go to the medical insurance department of the designated medical institution to go through the examination and approval procedures, and the expenses will be paid by myself first.10%, the rest90%By pooling funds and individuals in accordance with the provisions of the proportion of payment.
Article 9??The hospital bed fee standard of the insured is determined according to the bed fee standard of the general inpatient ward stipulated by the price department of the autonomous region. The bed fee for the isolated and critically ill patients shall be paid by the individual first.20%And the rest shall be paid according to the specified proportion.
Article 10??The emergency expenses (within three days) and observation expenses incurred by the insured in the designated medical institutions at the same level shall be directly settled by the designated medical institutions according to the prescribed standards.
The medical expenses incurred by the insured during business trip or visiting relatives in accordance with the relevant provisions for hospitalization or emergency rescue shall be paid by the insured unit or individual first. After the diagnosis and treatment, they shall go through the payment procedures at the Medical Insurance Bureau with valid certificates such as business trip certificate issued by the unit, medical records or copies of medical institutions, diagnosis certificate, compound prescription and medical expense receipt. For expenses incurred outside the district (excluding foreign countries, Hong Kong, Macao and Taiwan), the reimbursement ratio will be reduced on the basis of the local hospitalization reimbursement standard.5%The expenses incurred in the area shall be implemented according to the local hospitalization reimbursement standard.
Article 11??The medical expenses incurred by the insured who are transferred to designated medical institutions outside the district for diagnosis and treatment after examination and approval by the Medical Insurance Bureau shall be paid in advance by himself. After the diagnosis and treatment, the unit to which it belongs shall pay according to the relevant provisions after the examination and approval procedures for referral, medical records or copies, medical expense receipts, social security cards and other valid documents to the Medical Insurance Bureau, and the reimbursement ratio shall be reduced on the basis of local hospitalization reimbursement standards.5%. Those who are approved to be transferred to designated medical institutions outside the district for diagnosis, treatment and review are not hospitalized continuously.sevenWithin days of outpatient examination fees included in the basic medical insurance payment scope, the cost of payment in the directory.70%. The deductible standard for emergency treatment, transfer and review shall be implemented according to the inpatient deductible standard, and shall be combined with the inpatient deductible.
Article 12??Resettlement of retirees in different places and insured persons who need to work abroad for more than one year due to their work, medical expenses incurred in local designated medical institutions and designated retail pharmacies that meet the relevant provisions of outpatient service, hospitalization or emergency rescue, shall be paid by themselves or their families to the Medical Insurance Bureau with the approval form for medical treatment in other places, medical records or copies of the medical institutions or designated retail pharmacies where they live, diagnosis certificates, compound prescriptions, medical expense statements and other relevant documents. Hospitalization medical expenses shall be paid according to the proportion of hospitalization reimbursement where the insured is located, and outpatient medical expenses shall be paid from personal accounts.
Article 13??The insured person interrupts the basic medical insurance relationship.sixContinue the relationship within a month, according to5?Zan5%After paying the basic medical insurance premium and late payment fee during the interruption period in one lump sum, you can continue to enjoy the basic medical insurance benefits, but you don’t draw a personal account, and the payment period can be calculated continuously.;exceedsixIf the medical insurance relationship is continued for more than one month, press5?Zan5%The rate of one-time payment of medical insurance premiums and late fees during the interruption period, and the establishment of a one-year access period, the payment period can be calculated continuously, but not personal accounts, medical expenses during the interruption period will not be reimbursed.
第十四条??The medical insurance bureau shall manage the overall fund and individual account fund separately, and settle accounts in strict accordance with their respective payment ranges, and shall not occupy each other.
第十五条??The medical insurance bureau evaluates the performance of the basic medical insurance service contract for designated medical institutions every year. Meet the requirements of the contract, the autonomous region medical insurance bureau to pay the rest; If it is not reached, it will be deducted according to the agreement.
第十六条??本办法自发布之日起实行。
The original "Interim Measures for the Settlement of Basic Medical Insurance Expenses for Employees at the Inner Mongolia Autonomous Region" shall be abolished at the same time.
Basic medical insurance for employees at the same level in Inner Mongolia Autonomous Region
Measures for the management of examination and treatment of special medical items for referral and referral
In order to strengthen and standardize the management of referral, examination and treatment of special medical items for the insured of basic medical insurance at the corresponding level in the autonomous region, these measures are formulated according to the Measures for the Administration of Basic Medical Insurance for Employees at the Corresponding Level in Inner Mongolia Autonomous Region.
First, the examination and approval management of referral and transfer
the first??Designated medical institutions implement the responsibility system of first-visit medical institutions and first-visit doctors. When the insured really need to go to the designated medical institutions for hospitalization due to illness, the designated medical institutions should strictly check the hospitalization, and it is strictly forbidden to treat patients who do not meet the hospitalization conditions.
the second??In principle, the referral and transfer of designated medical institutions shall be transferred from low-level designated medical institutions to high-level designated medical institutions (except specialized diseases), and mutual transfer between designated medical institutions at the same level shall be limited to patients who cannot be treated because of the lack of certain necessary medical facilities or symptomatic treatment means in designated medical institutions.
Article??Designated medical institutions are limited by diagnosis and treatment technology and equipment. Insured personnel need to be transferred to designated medical institutions outside the region for diagnosis and treatment because of difficult and serious diseases. They must be consulted by experts organized by designated medical institutions with the qualification of transfer outside the region, and provide detailed information on the condition of transfer. The medical insurance department of designated medical institutions will review and register, and the director will sign and affix the special seal for transfer in our hospital. Only then can they be transferred.
Article 4??After the insured patients are diagnosed, they will return to the original designated medical institutions for treatment. The original designated medical institutions must receive patients for treatment, but they may not be listed for hospitalization.
Article 5??The time for the insured to go to the outpatient clinic of medical institutions outside the district for medical treatment istwentyDay; In principle, the hospitalization time shall not exceed60Days, such as critically ill need to extend the time, should be before the expiration of the transfer.10Go to the medical insurance bureau to handle the transfer extension formalities within days.
Article 6??Patients with infectious diseases and mental illness diagnosed by designated medical institutions for the first time must go through the transfer procedures by the Medical Insurance Bureau before they can go to specialized medical institutions for treatment.
Two, special medical examination and treatment of examination and approval management
Article 7??Special medical project inspection refers to the disease inspection conducted by medical institutions through special inspection instruments and equipment in the process of definite diagnosis, and the single cost is in200Yuan or above (inclusive)200Yuan) inspection items. such asCTNuclear magnetic resonance, etc.
Special treatment refers to the special treatment for a disease. Such as artificial organ installation, replacement, extracorporeal lithotripsy, etc.
Article 8??If the insured needs special examination and special treatment due to illness during hospitalization, the designated medical institution shall put forward suggestions by the attending physician and fill in the Approval Form for Special Examination and Special Treatment, and then go to the medical insurance department of the designated medical institution for examination and filing after being signed by the department director, and then go to the medical insurance bureau for examination and filing.
When urgent and critical insured patients need special examination and treatment, they can be examined and treated first.fiveGo through the relevant examination and approval procedures within days.
Article 9??The insured person really needs to make a single charge during hospitalization due to illness.200Yuan or above (inclusive)200Yuan) of the special inspection and treatment, the cost settlement in accordance with the relevant provisions of the "measures" in the settlement of basic medical insurance for employees at the corresponding level in the autonomous region.
Article 10??All designated medical institutions should strictly grasp the indications for examination and treatment of special medical items, and shall not arbitrarily expand the examination and treatment items. Medical expenses incurred by special inspections and special treatments that are not approved according to the prescribed procedures shall not be paid by the Medical Insurance Bureau.
Article 11??本办法自发布之日起实行。
The original "Interim Measures for the management of basic medical insurance referral and special medical items inspection and treatment of employees at the same level in Inner Mongolia Autonomous Region" shall be abolished at the same time.
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Basic medical insurance for employees at the same level in Inner Mongolia Autonomous Region
Measures for the administration of personal accounts and social security cards
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the first??In order to effectively strengthen the management of individual accounts of basic medical insurance at the autonomous region level and facilitate the insured to seek medical treatment and purchase medicines, these measures are formulated in accordance with the Measures for the Administration of Basic Medical Insurance for Employees at the Inner Mongolia Autonomous Region level.
the second??Autonomous Region Medical Insurance Management Bureau (hereinafter referred to as the Medical Insurance Bureau) shall establish the Basic Medical Insurance Personal Account one by one for all the insured persons at the corresponding level according to their citizenship numbers and unit codes, and shall be responsible for the supervision and management of their use.
Article??Personal accounts of basic medical insurance are managed by social security cards.
Article 4??The composition and sources of funds of individual accounts for basic medical insurance are detailed in the Measures for the Administration of Basic Medical Insurance for Employees at the Same Level in Inner Mongolia Autonomous Region.
Article 5??In case of special circumstances such as job transfer, retirement, etc., the medical insurance bureau will timely adjust the payment ratio and the proportion of personal account funds according to the relevant provisions in the Measures for the Administration of Basic Medical Insurance for Employees at the Inner Mongolia Autonomous Region.
Article 6??If the insured person dies due to illness or other reasons, it will stop being included in the personal account, and his personal account will be cancelled. If there is a balance in the personal account, his successor can continue to use it; Need to receive personal account balance funds by the unit medical insurance personnel to the medical insurance bureau to go through the formalities.
Article 7??The principal and interest of the personal account of the insured person are owned by the individual, and are used for medical consumption. Overexpenditure is not covered, and the balance is accumulated. The specific interest-bearing measures shall be implemented in accordance with the relevant provisions of the Measures for the Administration of Basic Medical Insurance for Employees at the corresponding level in Inner Mongolia Autonomous Region.
Article 8??Insured persons who seek medical treatment and purchase medicines at any designated medical institution or retail pharmacy in this city and use personal account funds are directly settled with medical institutions and retail pharmacies through social security cards. When the funds in the personal account are insufficient to pay, I will pay in cash.
Article 9??The main purpose of personal account funds.
(1) Medical expenses and medicine expenses for purchasing medicines in outpatient clinics of designated medical institutions and retail pharmacies.
(two) the overall fund Qifubiaozhun below the medical expenses.
(three) the overall fund Qifubiaozhun above, the highest payment limit below the personal burden of medical expenses. The part of the personal account that the funds are insufficient to pay shall be paid by myself.
Article 10??Insured personnel must meet the expenses stipulated in relevant policies when using personal account funds.
Article 11??Individual account funds are accounted for and managed separately from the overall fund, and shall not be misappropriated or mutually occupied, and shall not be used to balance the overall fund of basic medical insurance.
Article 12??If the insured needs to replace, reissue or cancel the social security card due to job transfer, post change, death, loss or damage of the social security card, the insured unit shall be responsible for handling it with valid certificates in time at the relevant departments.
Article 13??Insured personnel who find forged social security cards, fraud, impersonation and other violations will be punished according to the relevant provisions in the Measures for the Administration of Basic Medical Insurance for Urban Workers at the Inner Mongolia Autonomous Region.
第十四条??定点医疗机构、定点零售药店与医保局实行计算机联网结算，计算机接入自治区金保工程业务专网，使用统一结算软件和统一结算办法，接受医保局稽核与监督。
第十五条??医保局要加强对参保职工社会保障卡使用的监督和管理工作，发现问题及时纠正，确保网上结算数据正确。对违反医疗保险政策的行为，按照《中华人民共和国社会保险法》和服务协议相关规定进行处理。
第十六条??加强医疗保险个人账户支出管理，定点医疗机构、定点零售药店不得利用社会保障卡串换项目、虚开发票、套取个人账户基金。要加强政策宣传，引导广大参保人员合理规范地使用基本医疗保险个人账户基金，充分发挥个人账户在就医购药和保障健康方面的作用。
第十七条??社会保障卡的相关问题及使用方法，参保人可登录内蒙古自治区社会保障卡服务网在线查询办理或拨打12333电话服务热线进行咨询。
第十八条??本办法自发布之日起实行。
原《内蒙古自治区本级职工基本医疗保险个人账户及IC卡管理暂行办法》同时废止。
2014年10月27日
（此件公开发布）
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