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I want to apply

Please select the type of medical insurance benefit you want to apply for.

Urban and rural residents

Application for Basic Medical Insurance Benefits

Urban workers

Application for Basic Medical Insurance Benefits

  • when and where
  • Conditions and materials
  • contact number
  • Treatment standard
  • Payment standard

    Processing time:

    Perennial: Monday to Friday, 9:00 to 12:00, 1:00 to 4:00, except legal holidays

    Location:

    Liuzhou Social Insurance Bureau: 2 / F, North Building, Hedong Comprehensive Service Building, No. 7, Beiyi Lane, Gaoxin 1st Road, Liuzhou

    Conditions
    1. Record of resettlement in different places: living in different places across the overall planning area, working and studying in different places for more than 3 months;
    2. Recording of emergency medical treatment in a different place: The time for visiting relatives and travelling across the coordinated area should not exceed 3 months, and the patient will be hospitalized because of emergency;
    3. Referral to another place for record: Due to technical reasons, it is difficult to diagnose and treat, and it is necessary to transfer to a coordinated area for medical treatment.

    materials needed
    (1) “ Registration Form for Medical Records for Out-of-town Medical Treatment of Urban and Rural Residents of Liuzhou City ”, 1 original;
    (2) Provide corresponding materials according to different situations:
    1. Off-site resettlement filing
    Issue one of the following four types of certification materials: a residence permit issued by a public security organ; a residence permit issued in a different place; a long-term residence certificate issued by a non-local village committee or neighborhood committee stamped with an official seal; a work / enrollment certificate issued by a work unit or school in a different place.
    2. Off-site emergency medical treatment
    (1) Provide emergency and hospitalization-related certification materials (admission records, records of first journey of medical records, etc.) within 5 working days of admission and treatment, and one copy (original copy);
    (2) Telephone filing within 5 working days of admission;
    3. Off-site referral and referral
    (1) Intra-area referrals and referrals: Directly handled by designated medical institutions in the co-ordination area with qualifications for referrals and referrals.
    (2) Out-of-area referrals and referrals: Provide one copy of the "Liuzhou Urban and Rural Residents' Basic Medical Insurance Transfer Co-ordination Out-of-area Hospitalization Certificate" issued by the designated designated medical institution; the follow-up referral record needs to be provided: the same hospitalization last 1 copy of the discharge record or disease certificate (including the patient's continued treatment, stamped with the hospital work or the corresponding department stamp) (original copy);
    (3) One copy of the resident's medical insurance or social security card (the original is checked);
    (4) Resident ID card, if you entrust others to handle, you also need to provide the ID card of the agent, one copy (the original);
    (5) If the person who has filed in another place has changed the designated medical institution for outpatient special chronic diseases, there is no need to provide additional application materials.
    Note: The copies provided should be signed by the applicant (agent).

    0772-2859327 (Resident Medical Insurance Treatment Division); 0772-12333 (Labor Security Hotline)

    (1) Outpatient medical treatment

    1. Payment for general medical treatment. The township (community) designated medical institutions that canceled the drug bonus, the general medical treatment fee will be paid by the outpatient medical co-ordinator at 8.5 yuan / person-time, and the personal burden will be 1.5 yuan / person-time. For village-level clinics that have implemented the basic drug system, the general consultation fee is paid by outpatient medical staff at 5 yuan / person-time, and the individual burden is 1 yuan / person-time. After reaching the annual limit of outpatient medical co-ordination, the general medical treatment fee will no longer be paid.

    2. Reimbursement ratio. The insured person incurred medical expenses in the outpatient clinic of the designated medical institution that met the basic medical insurance payment scope. The single (or daily) outpatient fee at the township (community) level was not more than 60 yuan, and the single outpatient cost at the village level was not more than 30 yuan In the first-level designated medical institutions and the integrated management of village clinics (community health service stations), 65% and 75% of reimbursement will be made by the outpatient medical plan.

    The medical expenses incurred by the students in the outpatient clinics of the designated medical institutions within the school that meet the basic medical insurance coverage, and the personal out-of-pocket ratio shall not be lower than 10% in principle. Determined and specified in the service agreement with the social insurance agency.

    3. Limit payment. The insured person incurred medical expenses in the outpatient clinic of the designated medical institution, which met the basic medical insurance payment scope. Outpatient medical treatment was implemented with a limit payment of 200 yuan per person per year (including general diagnosis and treatment costs). The medical expenses in excess of the annual limit paid for the above part shall be paid by the individual. . The annual limit payment limit is adjusted in a timely manner.

    (2) Medical treatment for special chronic diseases in outpatient department

    起付标准。 1. Minimum payment standard. The minimum standard for outpatient special chronic medical expenses fund is 20 yuan / person · month, which is deducted from the total fund payment.

    2. Medical expenses reimbursement ratio. Outpatient special chronic disease medical expenses incurred in the outpatient clinics of designated medical institutions that meet the scope of basic medical insurance payment shall be shared between the fund and the individual. For details, please refer to the medical expenses sharing payment table for outpatient special chronic medical insurance.

    Basic medical insurance medical expenses sharing payment form for outpatient special chronic diseases

    Designated Medical Institution Level

    Fund payment

    Personal burden

    Level 1 and below

    85%

    15%

    Secondary

    70%

    30%

    City Level 3

    55%

    45%

    Autonomous Region III

    50%

    50%

    3. For patients with special chronic diseases in out-patient clinics who use Class B and C medicines in the Basic Medical Insurance "Pharmaceutical Catalog" and "Medical Service Projects" for treatment in designated medical institutions, the individual shall pay 15% and 30% respectively, and then the basic Medical insurance requires payment. Price classification management for medical materials (including body built-in materials) stipulated by the national and autonomous region's price authority can be charged separately. Below 200 yuan (including 200 yuan) is a Class A medical material; above 200 yuan and below 500 yuan (including 500 yuan) Yuan) for Class B medical materials; above 500 yuan for Class C medical materials.

    4. For those insured persons in poverty who have established a file to treat outpatients with special chronic diseases, increase the reimbursement rate by 5% on the basis of the medical expenses sharing payment table for outpatient basic chronic diseases. The identification, necessary information, and handling procedures for the establishment of the poverty-stricken people in the archives shall be formulated by the coordinating area according to the local reality.

    5. Limit payment. For each type of disease, annual fund limit payment is implemented. For details, please refer to the outpatient special chronic disease medical fee fund payment table. The medical expenses paid for the above part exceeding the annual fund limit shall be paid by the individual.

    Limit payment form for outpatient special chronic medical expenses fund

    Serial number

    Disease name

    Per person per year (yuan)

    1

    Coronary heart disease

    2000

    2

    Hypertension (high-risk group)

    2000

    3

    diabetes

    2000

    4

    Hyperthyroidism

    2000

    5

    Chronic hepatitis treatment consolidation period

    2000

    6

    Chronic obstructive pulmonary disease

    2000

    7

    psoriasis

    2000

    8

    Severe mental disorder

    3500

    9

    Rheumatoid arthritis

    2500

    10

    Sequelae of cerebrovascular disease

    2500

    11

    Systemic lupus erythematosus

    2500

    12

    Parkinson's syndrome

    2500

    13

    Chronic congestive heart failure

    2500

    14

    Cirrhosis

    2500

    15

    Active tuberculosis

    2500

    16

    Aplastic anemia

    12500

    17

    Nephrotic syndrome

    3500

    18

    epilepsy

    3500

    19

    Cerebral palsy

    4000

    20

    Myasthenia gravis

    3500

    twenty one

    Rheumatic heart disease

    2500

    twenty two

    Cor Pulmonale

    2500

    twenty three

    Ankylosing spondylitis

    2000

    twenty four

    Hypothyroidism

    2000

    25

    Severe and intermediate thalassemia

    30000

    26

    hemophilia

    30000

    27

    Chronic renal insufficiency / renal dialysis

    10000/30000

    28

    Various malignant tumors

    30000

    29

    Anti-rejection immunomodulatory therapy after organ transplantation

    30000

     

    (IV) Emergency medical treatment

    1. Insured persons who are in emergency at the third, second, and first-level designated medical institutions due to illness, stay in the emergency department, and do not transfer to the hospital for treatment. Medical expenses that comply with the basic medical insurance payment scope are subject to 300 yuan and 200 yuan for each fund. RMB 100 will be deducted from the total payment of eligible funds; the remaining medical expenses that meet the requirements will be reimbursed in accordance with the hospitalization regulations.

    2. The insured person stays in the emergency medical institution of the designated medical institution due to the illness, and directly transfers to the hospital for treatment. The medical expenses that meet the basic medical insurance payment scope are combined and calculated as one hospitalization. The fund payment standard and reimbursement ratio are based on Hospitalization regulations are implemented.

    3. The medical expenses for emergency treatment and inpatient treatment are combined with the medical expenses for hospitalization to calculate the maximum annual payment limit of the insured individual.

    (5) Medical treatment in hospital

    1. Bed standard payment standard. The bed fee fund payment standard is 20 yuan / bed · day. Bed charges below the standard will be paid based on actual occurrences, and those above the standard will be paid by individuals.

    2. Fund payment standards. During the insured year, the insured person was hospitalized for the first time at a third, second, or first-level designated medical institution due to illness, and the fund payment standards were 600 yuan, 300 yuan, and 100 yuan respectively; for the second and above hospitalization, each fund The minimum payment standards are 300 yuan, 200 yuan, and 100 yuan, which are deducted from the total fund payment.

    3. Medical expenses reimbursement ratio. The basic medical insurance medical expenses below the maximum payment limit of the fund shall be shared by the fund and the individual. For details, please refer to the basic medical insurance medical expenses sharing payment table below the maximum payment limit of the inpatient treatment fund.

    Basic medical insurance medical expenses sharing payment table below the maximum payment limit of the inpatient treatment fund

    Designated Medical Institution Level

    Fund payment

    Personal payment

    Level 1 and below

    90%

    10%

    Secondary

    75%

    25%

    Third grade

    60%

    40%

    Autonomous Region III

    55%

    45%

    If the insured uses in-patient medical treatment at designated medical institutions (including in-hospital areas), the use of Class B and C medicines in the Basic Medical Insurance Drug Catalog and Medical Service Project shall be paid by the individual at 15% and 30% respectively. Then, pay according to the basic medical insurance regulations. Price classification management for medical materials (including body built-in materials) stipulated by the national and autonomous region's price authority can be charged separately. Below 200 yuan (including 200 yuan) is a Class A medical material; above 200 yuan and below 500 yuan (including 500 yuan) Yuan) for Class B medical materials; above 500 yuan for Class C medical materials.

    4. For those insured persons who are insured by the establishment of a file, the reimbursement ratio shall be increased by 5% on the basis of the basic medical insurance medical expenses sharing payment form below the maximum payment limit of the inpatient treatment fund.

    (6) Medical treatment for family beds

    For family beds established by insured persons at designated medical institutions at levels three, two, one, and below, the minimum payment for each fund is 300 yuan, 200 yuan, and 100 yuan, which is deducted from the total fund payment. The medical expenses of family beds are settled in a limit, and the fund payment per person per day is controlled within 60 yuan, and the costs are settled within the limit indicators, and the excess will not be paid. The medical expenses of the family bed and the hospitalization expenses are combined to calculate the maximum annual payment limit of the insured individual. During the insured year, the maximum payment limit of the fund for the insured person is 6 times the per capita disposable income of the Guangxi urban residents in the previous year as recently announced by the statistical department before January 1 of each year. The annual maximum payment limit of the fund is fixed for one year in the natural year, and it will not be adjusted in the middle of the year.

    (VII) Treatment for hospitalization in different places

    If the insured is hospitalized for treatment outside the autonomous region or autonomous region, the medical expenses that meet the basic medical insurance payment scope shall be reimbursed as follows:

    、参保人员经社会保险经办机构同意转院住院治疗的,在参保地住院治疗报销比例的基础上,基金报销比例分别降低5%、 10%;未经同意转院的,基金报销比例分别降低15%、20%。 1. If the insured person agrees to be transferred to hospital for hospitalization through the social insurance agency, the fund reimbursement ratio will be reduced by 5% and 10% based on the reimbursement ratio for inpatient treatment at the place where the insurance is insured; Reduced by 15%, 20%.

    、长期(3个月以上)跨统筹地区异地居住,经参保地社会保险经办机构办理就医备案住院的,按参保地住院治疗报销比例执行;未经备案的,基金报销比例分别降低15%、20%。 2. Long-term (more than 3 months) living in a different place across the overall planning area and undergoing medical registration and hospitalization through the social insurance agency in the participating insurance area shall be implemented according to the reimbursement ratio for inpatient treatment in the participating insurance area; 15%, 20%.

    、短期(3个月以内)跨统筹地区外出探亲、旅游等因急病住院的,在入院治疗5个工作日内向社会保险经办机构办理备案手续的,按参保地住院治疗报销比例执行;逾期或未备案的,基金报销比例分别降低15%、20%。 3. For short-term (within 3 months) out-of-court visits to relatives or tourists who are hospitalized due to an acute illness across the co-ordinated area, if they go to the social insurance agency within 5 working days of admission treatment, they will go to the social insurance agency for reimbursement; If it is overdue or not filed, the fund reimbursement ratio will be reduced by 15% and 20%, respectively.

    、参保人员异地住院的医疗费,与在统筹地区住院医疗费合并计算参保个人年度基金最高支付限额。 4. The medical expenses of the insured persons who are hospitalized in different places shall be combined with the hospitalization expenses in the overall planning area to calculate the maximum annual payment limit of the insured individual.

    (8) Medical treatment for accidental injury

    1. In the event of an accidental injury to a student on campus or at a school-organized event, or during school trips, an outpatient medical fee of less than 5,000 yuan (including 5,000 yuan) that meets the requirements during the year shall be paid by the fund 80%; For hospitalization, payment shall be made in proportion to the hospitalization regulations.

    2. Medical expenses incurred due to accidental injury of the insured 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.

    ① If the basic medical insurance payment scope is met, the social insurance agency shall pay the corresponding part of the medical expenses in advance according to the provisions of the basic medical insurance fund payment. The general outpatient medical expenses shall be paid by the outpatient department as a whole; the medical expenses incurred for inpatient treatment shall be shared according to the inpatient regulations. Proportional payment; medical expenses paid in advance are included in the maximum annual payment limit of the insured person.

    ② Medical expenses exceeding the liability of the third party are not covered by the advance payment, and are borne by the individual.

    ③ The time point for applying for advance payment shall apply for advance payment within one year after the end of the hospitalization treatment and the medical expenses have been settled with the medical institution. If the application is overdue, the social insurance agency will no longer accept the application for advance payment.

    ④ After the basic medical insurance fund is paid in advance, the social insurance agency has the right to claim compensation from a third party.

    According to the "Notice of the Ministry of Human Resources and Social Security of the Ministry of Finance on Doing a Good Job in the Basic Medical Insurance for Urban Residents in 2016" (Ministry of Human and Social Development [2016] No. 43) and the "Ministry of Finance of the National Health and Family Planning Commission on Doing Well in 2016 The Notice on New Rural Cooperative Medical Work (Guo Wei grass-roots [2016] No. 16) and other provisions stipulated that the basic medical insurance for urban and rural residents in our district in 2017 will pay 150 yuan as an individual. In the future, the annual payment standards for urban and rural residents will be implemented in accordance with national and autonomous region regulations.

    According to the "Guidance Opinions of the State Council on Pilots of Basic Medical Insurance for Urban and Rural Residents" (Guo Fa [2007] No. 20) and "Guidance Opinions of the Autonomous Region People's Government on Pilots of Basic Medical Insurance for Urban and Rural Residents" (Gui Zheng Fa [2007] No. 37) And "Notice of the Ministry of Civil Affairs, the Ministry of Finance and the Ministry of Labor and Security on Doing a Good Job in Residents in Urban and Rural Residents Participating in Basic Medical Insurance for Urban and Rural Residents" (Min Fa [2007] No. 156) and the Finance of the Human Resources and Social Security Department of the Disabled Persons' Federation of the Autonomous Region Notice of the Ministry of Civil Affairs on the implementation of the full government subsidy for urban and rural residents participating in the basic medical insurance for urban and rural residents with severe disabilities (Gui Can Lian Zi [2012] No. 64) and other documents. Target, severely disabled, low-income families aged 60 and older, minors, five-guarantee households, poverty-stricken people who set up a file, the only-child households in rural areas implementing family planning policies, parents of twin-ligated households, and Children, residents of urban and rural areas from 0 to 20 kilometers of the border, etc. Give subsidies.

Counter No. 42-44 of the second floor lobby of the Social Security Bureau fills in the " Registration of Medical Registration in Other Places " and provides supporting materials for registration.

Things to know:

1. Temporary out-of-office persons who do not go out for less than 3 months do not need to go through registration formalities for out-of-office visits.

2. The following certification materials are all valid certification materials for registration of out-of-office visits:

My off-site property certificate; my off-site residence certificate; my off-site residence certificate; proof of the unit's overseas presence; my residence certificate of relatives visiting with my relatives in different places and my off-site residence certificate, real estate certificate, temporary residence certificate, unit certificate, etc.

3. Off-site visits are divided into temporary off-site visits, short-term off-site visits, and long-term off-site visits.

The medical expenses within the scope of the basic medical insurance incurred by the clinic shall be calculated based on a certain percentage, and the expenses shall be paid by the individual; the rest shall be reimbursed according to the relevant standards in the city.

The ratio of first-time payment is:

1. Temporary and short-term out-of-site medical treatment: 10% of hospitalization expenses for medical treatment in the autonomous region; 20% for medical treatment outside the autonomous region.

2. Long-term out-of-office treatment: 5% of hospitalization expenses for medical treatment in the autonomous region; 10% for medical treatment outside the autonomous region.

3. Outpatient chronic disease treatment costs: 5% of consultations in the autonomous region; 10% of consultations outside the autonomous region.

Flow Description:

Liuzhou Social Insurance Bureau <br /> Contact: (0772) 2822841
Address: No. 7, Beiyi Lane, Gaoxin 1st Road. Routes: 69, 75, 76, Express 5 / Express 2 Office hours: 9:00 to 12:00, Monday to Friday

Location diagram:
  • Social Security Information

  • Personal service

  • Unit work

  • Foreign Service Phone

Organizer: Liuzhou Big Data Development Bureau

GuiGong Network Security No. 45020502000014

Organizer: Liuzhou Municipal People's Government

Gui ICP No. 05009280

Management and maintenance: Liuzhou Information Construction Management Center

Website identification code: 4502000034