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Interpretation of the ninth stage trade union members' mutual aid and supplementary medical insurance policy in Weihai
1. Safeguard the main contents of the project
1. Retired personnel, retirees and persons who have long been off the post (long term leave is not allowed to take part in the medical period according to the period stipulated in the period stipulated in the period of work for the employees who are sick or not for the injury to the workers. "
The medical term refers to the time limit for the workers to stop working and get rid of the labor contract due to illness or non occupational injury. The provisions of the third regulations on medical treatment for sick or non injured workers are:
The medical period of three months to twenty-four months is given in accordance with the actual number of years and the years of work in the unit because of the illness or non injury caused by workers and the need to stop working medical treatment.
(1) if the actual working life is less than ten years, the working life in this unit is less than five years for three months, and five years or more for six months.
(two) the actual working years of more than ten years, the working life of the unit for more than five years for six months; five years or more than ten years for nine months; ten years or more than fifteen years for twelve months; fifteen years and less than twenty for eighteen months; more than five months for more than one month.
2. The number of members of the insured units under 5 (including) more than 25 persons shall be attended by all members; the number of members of the insured unit is more than 25 (including), and the number of insured persons shall not be less than 80% of the number of basic medical insurance for urban workers.
The staff under 5 persons should participate in the insurance, and all members must be insured and meet the following two conditions: first, the unit has established a trade union organization; and two, the detailed list of the relevant approval and payment of social security must be carried with the establishment of a trade union organization.
3. Payment method: payment is divided into two ways: public account transfer and cash bank deposit. No cheque or cash payment is accepted.
Transfer to public account: after the online examination of the application materials is qualified, the insured units can transfer the payment through the unit net bank payment. Please be sure to note the full name of the insured unit (do not write the abbreviation) and the "union project", and retain the screenshots / business receipts on the success page of the transfer.
Cash bank deposit: if the application material is checked online, please pay the bank cash payment after paying the cash to the bank. It is necessary to provide the proof of no public account (Annex 5) and the photocopy of the identity card of the operator.
4, hospitalization allowance is limited to the number of days of operation or transfusion during hospitalization period in a public medical institution due to various diseases or accidental injuries within a guaranteed period.
The scope of hospitalization allowance should be removed to more than two, and extended to all public medical institutions, including township hospitals.
5, the number of days of hospitalization is 90 days (two days of hospitalization is not more than 30 days, regarded as a hospitalization). The number of days of accumulative payment is limited to 180 days when the insured member has been hospitalized several times.
Attention: in the hospitalization allowance insurance, the two hospitalization interval is not more than 30 days. It is considered a hospitalization.
6, new 4 yuan special health package guarantee responsibility.
New male and female specific disease protection and accidental disability protection. The maximum guarantee is 4000 yuan.
Two, matters needing attention and further clarified contents.
1, units can use union funds to provide unified insurance for workers.
2, the insurance payment time is: from March 12, 2018 to April 30th, overdue online insurance system is closed, no longer processed.
3, payment is divided into two ways: transfer to public account and cash bank, and do not accept Cheque or cash payment. The two guarantee items, cash bank deposit, need to be issued without a certificate of public account and a copy of the identity card of the operator.
4, electronic invoice problem: the invoice of hospitalized medical insurance can be downloaded automatically to the insurance system; the invoice of the inpatient allowance insurance can be downloaded on the Internet and can be delivered (in the insurance system automatically).
5, intertemporal problem: when the continuous insured member has a cross term claim situation, it is unified to the previous guarantee period to claim compensation, and the medical expenses of the latter guarantee period will no longer be added. The duration of hospitalization is 3 months, that is, 90 days after discharge, claims must be applied.
6, in the hospital medical security projects, excluding the responsibilities stipulated: the waist, neck, joint inflammation, skin type of four kinds of diseases, the use of acupuncture, massage, moxibustion, traditional Chinese medicine and other non operative treatment costs, no reimbursement. The identification of disease is based on the main diagnosis of hospitalized cases.
7. The insured members apply for the claim for the inpatient guarantee project, which is required within 90 days from the date of the hospital (or the medical insurance Department), which is finally issued by the hospital (or the medical insurance Department) for the special receipt of the medical expenses or the certificate of settlement. (up to half a year), but the duration of hospitalization is 3 months, that is, 90 days after discharge.
8. Foreign inpatients, such as direct settlement, refer to the relevant provisions of the reimbursement for "hospitalized medical items" or "hospitalization Allowance Items", and the reimbursement for the medical insurance institutions of the insured place should be submitted in addition to the copies of the inpatient invoices and the overall balance sheet issued by the medical insurance of Weihai (printed by the medical insurance office or printed on the Internet by the Internet). Other materials are consistent with local reimbursement materials.
9. If the insured member has other commercial insurance to apply for medical expenses compensation, or the end of the disease insurance needs to be reimbursed at the end of the year, please keep a good copy of the material when the claim is required for the use of the subsequent reimbursement.