Basic Medical Insurance for Urban and Rural Residents in Beijing
1. insured persons hold social security cards for door-to-door (emergency) medical treatment and settlement.
When seeking medical treatment, (I) insured persons should hold their social security card and the "Handbook of outpatient and emergency medical records of medical institutions in Beijing area" (hereinafter referred to as "medical record manual"), and take the initiative to show it. The insured shall ensure the continuous use of the Medical Record Manual.
When (II) the insured person to seek medical treatment, the doctor of the designated medical institution must check the social security card and the "Medical Record Manual", and write the "Medical Record Manual" in accordance with the health administration regulations for disposal. The medical insurance fund will not pay for medical expenses that violate the regulations caused by failing to check and write the "Medical Records Manual" as required, and fraudulently using other people's social security cards for medical treatment.
When (III) the insured to settle medical expenses, the designated medical institution shall issue a fee bill for the insured, advance the medical expenses that should be paid by the medical insurance fund, and the remaining expenses shall be paid by the insured.
(V) insured persons need to be referred for treatment due to their illness, the doctor of the designated medical institution shall issue the "Beijing Medical Insurance Referral (Hospital) Form", and the medical insurance office of the designated medical institution must use the insured person's social security card to handle the referral procedures for them.
After the insured person goes through the referral procedures, the medical expenses incurred in the transfer to the designated medical institution can be settled in accordance with the relevant provisions of medical insurance.
2. Insured Persons Hold Social Security Cards for Hospitalization and Settlement
(I) general hospitalization
1. The insured person shall use his social security card for hospitalization on the day of admission.
2. When the insured person holds the social security card to settle the medical expenses, the designated medical institution shall carefully check whether the social security card of the medical insured person is used by himself, complete the settlement and declaration of medical expenses in time, and issue a fee bill for the insured person to advance the medical expenses that should be paid by the medical insurance fund. The remaining costs are paid by the insured.
(II) outpatient special disease
1. Before the insured person carries out outpatient or inpatient treatment of special diseases, he should first hold the social security card to go through the filing procedures in the designated medical institution for special diseases selected by him.
2. When the insured person settles the medical expenses for special diseases, the designated medical institution shall issue a fee bill for the insured person, advance the medical expenses that should be paid by the medical insurance fund, and the remaining expenses shall be paid by the insured person.
(III) Emergency Stay
Insured personnel emergency observation, medical treatment, settlement process according to the requirements of ordinary hospitalization. The designated medical institution shall establish a medical record for the insured and manage it in accordance with the relevant provisions of the health administrative department. At the time of fee settlement, the insured person shall be provided with a fee bill, advance the medical expenses that should be paid by the medical insurance fund, and the remaining expenses shall be paid by the insured person.
(IV) transfer
If the insured person needs to be transferred to a hospital for treatment due to his illness, the doctor of the designated medical institution shall issue the "Beijing Medical Insurance Referral (Hospital) Form", and the insured person shall go to the medical insurance office of the designated medical institution to go through the transfer procedures, and the designated medical institution shall promptly The insured person handles the settlement.
3. Insured Personnel Manual Reimbursement of Medical Expenses
(I) the period when the insured person has not issued a social security card, or the social security card has been lost (damaged) and applied for replacement (replacement) of the social security card, when going to the designated medical institution for medical treatment, they need to take the initiative to present the "Certificate of Receipt of New and Supplementary (Replacement) Social Security Card", and the medical expenses incurred shall be fully settled by the insured person and the designated medical institution. Designated medical institutions should collect relevant information according to the "Certificate of Receipt of Newly Issued and Supplementary (Exchange) Social Security Card", upload the details of medical expenses, and issue relevant documents for the insured.
(II) when the insured person holds the card for medical treatment, if the card is damaged or other reasons cannot be settled in real time, the medical expenses incurred shall be fully settled by the insured person and the designated medical institution. The designated medical institution shall collect relevant information according to the social security card, upload the details of medical expenses, and issue relevant documents for the insured.
(III) medical expenses incurred when the insured does not hold a card in the emergency department or seek medical treatment in a different place shall be fully settled by the insured and the designated medical institution.
If the above-mentioned full settlement of medical expenses incurred by the (IV) insured meets the relevant provisions of medical insurance, the insured shall submit the relevant documents to the street (township, town) social security office (hereinafter referred to as the "social security office"). After summarizing, the social security office will report to the district medical insurance agency in accordance with the relevant business process from 1 to 20 days of each month.



Basic Medical Insurance for Urban and Rural Residents in Beijing
Payment standard
 

Reimbursement Standard

Medical management
The elderly in urban and rural areas and residents of working age implement the system of "first diagnosis at the grass-roots level". They need to go to their designated grass-roots hospitals for the first diagnosis. After the first diagnosis and referral, they can go to their designated hospitals and Class A, traditional Chinese medicine and Junior College designated hospitals for medical treatment. The effective time limit for a referral is 180 days. The medical insurance fund for urban and rural residents shall not pay for the outpatient (except emergency) medical expenses incurred by other designated medical institutions without the first referral of primary designated medical institutions. Students and children do not need the first consultation at the grass-roots level.
When seeking medical treatment, the insured person takes the initiative to show the social security card. When settling the expenses, it belongs to the part paid by the urban and rural residents' medical insurance fund, which is paid by the designated medical institution, and the rest of the expenses are settled by the individual and the designated medical institution.
Payment time
Basic medical insurance for urban and rural residents from September 1 to November 30 each year for the centralized insurance payment period.



Basic Medical Insurance for Urban Employees in Beijing
Composition of individual accounts for 1. basic medical insurance:
1. Basic medical insurance premiums paid by individual employees;
2. The basic medical insurance premium paid by the employing unit that is transferred to the personal account in accordance with the regulations;
3. Interest on the amount of personal account storage;
4. Other funds incorporated into personal accounts in accordance with the law.
How 2. Employers and Individuals Pay Basic Medical Insurance Premiums
The basic medical insurance premium shall be paid jointly by the employer and the individual employee.
The employer shall pay the basic medical insurance premium at 9% of the sum of the wage base of all employees. Employees pay basic medical insurance premiums at 2% of their average monthly salary of the previous year. If the average monthly salary of the employee is lower than 60% of the average monthly salary of the employees in the city in the previous year, 60% of the average monthly salary of the employees in the city in the previous year shall be the base of payment; If it is higher than 300, it will be paid on the basis of 300. If it is impossible to determine the average monthly salary of the employee in the previous year, the average monthly salary of the employees in this city in the previous year shall be the base of the payment wage. Persons who have retired before the implementation of the Beijing Medical Insurance Regulations will no longer pay basic medical insurance premiums.
Mutual payments for large medical expenses are paid jointly by the employer and the individual. The employer shall pay 1% of the sum of the wage base of all employees, and the employees and retirees shall pay 3 yuan per month. Mutual funds for large medical expenses are paid together with the monthly payment of basic medical insurance premiums.
How the 3. basic medical insurance fund is transferred to the individual account.
The basic medical insurance premium paid by the employer shall be transferred to the individual account according to a certain proportion, and the standard shall be:
1. Employees under the age of 35 shall be transferred to personal accounts at 0.8 per cent of their monthly wage base;
2. Employees over 35 years old but under 45 years old shall be transferred to personal accounts according to 1% of their monthly salary base;
3. Employees over 45 years of age shall be transferred to personal accounts according to 2% of their monthly salary base;
4. outpatient and emergency medical treatment instructions
◆ Medical advice
1. The insured must hold the Beijing Social Security Card and the "Handbook of Outpatient and Emergency Medical Records of Medical Institutions in Beijing" (hereinafter collectively referred to as the social security card and the "Outpatient Medical Records" real-name system for medical treatment, and show them as required;
2. During the period when the newly insured person has not issued the social security card and the social security card is lost and reissued, he shall take the "Certificate of New Issue and Replacement (Replacement) Social Security Card" (I. e. "Temporary Medical Treatment Card") for medical treatment and show it voluntarily as required;
3. You can go to the designated hospital of your choice for medical treatment, or to the designated Junior College hospital, designated Chinese medicine hospital, and Class A hospital in Beijing;
4. If you cannot go to the above-mentioned designated medical institution for medical treatment due to an emergency, you can go to the nearest medical insurance designated medical institution for emergency treatment. After the condition is stable, you should promptly transfer back to your designated medical institution;
5. When you need to go to the designated drugstore for medical insurance, you must hold the medical insurance prescription issued by the designated medical institution, and the medical insurance office of the designated medical institution shall be stamped with the "Beijing Basic Medical Insurance Prescription Special Seal"
6, the insured social security card loss, on-the-job retirement, insurance conversion (urban and rural residents to urban workers), etc., must hold the social security card to the social security center for information synchronization.
7. The insured person's condition is stable and needs to take similar drugs for a long time, but due to mental illness or mobility inconvenience, long-term bedridden and other reasons, they cannot go to the designated hospital for medical treatment, the family members of the insured person can hold the patient's valid identity certificate (ID card and social security card), the outpatient medical record manual of the confirmed hospital or the discharge diagnosis certificate, and go to the designated hospital to prescribe drugs.
◆ Reimbursement standard
1. On-the-job personnel
In a year, if the medical expenses for outpatient and emergency treatment exceed 1800 yuan, 70% of the mutual funds for large medical expenses will be paid, and 90% of the mutual funds for large medical expenses will be paid when the community seeks medical treatment. Outpatient, emergency large medical expenses a year to pay a maximum of 20000 yuan.
(2) Retirees
In a year, the total amount of outpatient and emergency medical expenses exceeds 1300 yuan. Retirees under the age of 70 will pay 85% of mutual funds for large medical expenses, retirees over the age of 70 will pay 90% of mutual funds for large medical expenses, and 90% of mutual funds for large medical expenses will be paid when seeking medical treatment in the community. Outpatient, emergency large medical expenses a year to pay a maximum of 20000 yuan.
Instructions for 5. hospitalization
(I) medical advice
1. You must hold the Beijing Social Security Card (or "Certificate of New and Supplementary (Exchange) Social Security Card") (hereinafter collectively referred to as social security card) for real-name medical treatment;
2. During the period when the insured did not issue the social security card due to the new insurance and the social security card was lost and reissued, the insured should seek medical treatment with the Certificate of New Issuance and Replacement (Replacement) of Social Security Card;
3. You can go to the designated hospital of your choice for medical treatment, or to the designated Junior College hospital, designated Chinese medicine hospital, and Class A hospital in Beijing;
4. If you cannot go to the designated medical institution selected by me due to emergency, you can go to the nearest designated medical institution for emergency treatment. After the condition is stable, you should transfer back to your designated medical institution in time;
5, hold the social security card to the hospital for hospitalization procedures, at the same time in accordance with the provisions of the hospital to pay a certain amount of advance payment (for the payment line, self-paid and self-paid expenses);
6. During hospitalization, if you use drugs, diagnosis and treatment items and service facilities that should be paid by individuals at their own expense or at their own expense, you should sign a "self-expense agreement" with the hospital to prevent disputes due to self-expense items;
7. If the insured person needs to be transferred to a hospital for treatment in the city due to his illness, he shall be approved by the hospital medical insurance office. If he is transferred to a hospital within 24 hours, he shall be treated as continuous hospitalization;
8. Discharge with medicine: in principle, the amount should not exceed 7 days, and the amount can be prescribed for two weeks if the movement is inconvenient.
(II) reimbursement standard
1. The minimum payment standard for the first hospitalization in a year is 1300 yuan, and the minimum payment standard for the second and subsequent hospitalization is 650 yuan;
2. For medical expenses paid by the basic medical insurance co-ordination fund, the maximum payment limit in a year is 100000 yuan, and the cumulative maximum payment limit for large mutual funds is 200000 yuan. Refer to the chart for specific reimbursement methods.
3. For medical expenses incurred again after hospitalization reimbursement exceeds 100000 in a year, the on-the-job personnel shall be paid 85% by the mutual aid fund for large medical expenses, 15% by individuals, 90% by retirees (including unified supplementary insurance for retirees) and 10% by individuals.
4. The hospitalization settlement period for common diseases is 90 days, and the next starting line beyond 90 days is regarded as the second hospitalization.

Basic Medical Insurance Co-ordination Fund Reimbursement Chart
 

Medical insurance publicity
In order to gradually explore the coordination mechanism between medical insurance payment standards and purchase prices, on the basis of ensuring quality and supply, for this national centralized procurement of drugs, the generic name belongs to the Beijing Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2017 Edition) ", the basic medical insurance fund shall be paid in accordance with the following principles:
(I) selected drugs are paid at the selected price, and the reimbursement rate remains unchanged.
(II) the price of the unselected drug is higher than the price of the selected drug with the same generic name, on the basis of price linkage, the proportion of individual first burden will be increased by 10% (except for the disabled revolutionary soldiers of the first to sixth levels), patients and medical institutions will be guided to use the selected varieties, and non-selected enterprises will be encouraged to take the initiative to reduce prices.
If the price of the (III) drug is lower than the price of the selected drug in the same generic name, the actual price shall be the standard of payment, and the reimbursement ratio shall remain unchanged.
(IV) generic drugs under the same generic name that have not passed the consistency evaluation, the payment standard is in principle not higher than the price of the selected drug.





Beijing Basic Medical Insurance Special Disease Filing Process
In order to implement the notice on issues related to adjusting the filing process of special diseases of basic medical insurance in Beijing issued by Beijing medical insurance affairs management center (jjyingfa [2016] No. 30) and the notice on issues related to adjusting and improving the outpatient special disease policy of basic medical insurance issued by Beijing municipal human resources and social security bureau (jyingfa [2017] No. 179):
Article 1 Beijing Hospital of Integrated Traditional Chinese and Western Medicine carries out special diseases: malignant tumor outpatient treatment and renal dialysis treatment. Insurance types: urban workers (in-service, retired), urban and rural residents, over-transfer personnel.
Article 2 The attending doctor shall fill in the "Beijing Medical Insurance Special Disease Filing Application Form" for patients who meet special diseases in a timely manner and formulate a treatment plan. Timely establish medical records for special diseases for patients, strictly follow the requirements of medical hospitalization medical records and the management regulations of medical insurance on special diseases, carefully write medical records and enter relevant expense items during each treatment.
Article 3 The staff of the Medical Insurance Office shall read the social security card in the medical insurance business component, enter relevant information, and print the "Beijing Medical Insurance Special Disease Record Form" in duplicate. After the patient himself confirms the signature, he shall affix the seal of the designated medical institution. One copy is given to the patient and one copy is filed and managed by the medical insurance office together with the "declaration form. Staff members who are resettled in other places or stationed in other places for a long time need to go through the filing procedures at the handling agency in the insured area.
Article 4 If a patient needs to change the designated medical institution for special diseases due to circumstances, he shall first settle the expenses for special diseases, upload the settlement data to the system in time, and confirm the success of warehousing. Hold the social security card to go through the cancellation formalities at the designated medical institution originally selected for special diseases. The medical insurance office of the hospital shall issue the "Beijing medical insurance special disease record cancellation form", which shall be sealed by the designated medical institution after being confirmed and signed by the patient. One copy is given to the patient and the other is archived and managed by the medical insurance office. For example, in the event of a network failure, the patient will hold the social security card and the "Beijing Medical Insurance Special Disease Medical Expenses Settlement Certificate" to go through the cancellation procedures at the agency in the individual insurance payment area. The next day, hold the social security card and "cancellation form" to the newly selected designated medical institutions for special diseases for filing procedures.
Article 5 The validity period of special diseases is 360 days, and a new application for filing must be made after the expiration of the time limit, otherwise it shall be deemed invalid.

Medical Insurance Single Disease Operation Project in Our Hospital
1. Acute appendicitis
2. Surgical treatment of inguinal hernia and femoral hernia
3. Thyroid surgery
4. Surgical treatment of benign ovarian tumor
5. Surgical treatment of uterine leiomyoma
6. Surgical treatment of cholecystolithiasis
7, (foot thumb) valgus surgical treatment