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Interpretation of the Complementary Medical Insurance Project Policy for the 9th Labor Union Member of Weihai

Interpretation of the Complementary Medical Insurance Project Policy for the 9th Labor Union Member of Weihai

  • Categories:Union
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  • Origin:
  • Time of issue:2018-05-07
  • Views:802

(Summary description)1. Retired personnel, retired personnel, and long-term sick leave for leave (long-term leave for sick leave refers to the medical period that exceeds the medical period stipulated in the "Provisions on the Medical Period for Sickness or Non-Work Injury of Enterprise Employees" in accordance with the working years) shall not participate in this project .

Interpretation of the Complementary Medical Insurance Project Policy for the 9th Labor Union Member of Weihai

(Summary description)1. Retired personnel, retired personnel, and long-term sick leave for leave (long-term leave for sick leave refers to the medical period that exceeds the medical period stipulated in the "Provisions on the Medical Period for Sickness or Non-Work Injury of Enterprise Employees" in accordance with the working years) shall not participate in this project .

  • Categories:Union
  • Author:
  • Origin:
  • Time of issue:2018-05-07
  • Views:802
Information

1. The main adjustment content of the guarantee project

1. Retired personnel, retired personnel, and long-term sick leave for leave (long-term leave for sick leave refers to the medical period that exceeds the medical period stipulated in the "Provisions on the Medical Period for Sickness or Non-Work Injury of Enterprise Employees" in accordance with the working years) shall not participate in this project .

  Medical period refers to the time period during which employees of an enterprise cannot terminate their labor contract due to illness or non-work-related injuries. Article 3 of the "Regulations on Medical Treatment Period for Sickness or Non-Work Injury of Enterprise Employees" stipulates:

   When an enterprise employee needs to stop working for medical treatment due to illness or non-work-related injury, according to the actual working years and working years in the unit, a medical period of three to 24 months will be given:

   (1) If the actual working life is less than ten years, the working life of the unit is less than five years is three months; if the working life is more than five years, it is six months.

(2) If the actual working life is more than ten years, the working life of the unit is six months if the working life is less than five years; nine months if the work is more than five years but less than ten years; twelve months if the work time is more than ten years and less than 15 years ; The period between 15 years and 20 years is 18 months; the period over 20 years is 24 months.

2. If the number of active members of the insured unit is more than 5 (inclusive) and less than 25, all members must participate; if the number of active members of the insured unit is more than 25 (inclusive), the number of insured members shall not be less than that of the unit participating in the town 80% of employees with basic medical insurance.

To participate in the insurance, all employees of a unit with less than 5 persons must be insured and meet the following two conditions: one is that the unit has established a trade union organization; the other is that the relevant approval for the establishment of the trade union and the list of specific personnel who pay social security must be accompanied when participating in the insurance. .

  3. Payment method: Payment is divided into two methods: transfer to public account and cash bank deposit. Cheque and cash payment are not accepted.

   Transfer to a public account: After the application materials are approved online, the insured unit can transfer funds through the unit's online banking payment method. Be sure to note the full name of the insured unit (do not write abbreviations) and the words "Union Project" when transferring funds, and save the screenshot of the successful transfer page/business receipt.

  Cash bank deposit: After the application materials are qualified online, please deposit the cash at the bank and keep the bank cash payment receipt. If you choose this method to pay, you need to provide a certificate of non-public account (Annex 5) and a copy of the ID of the handler.

  4. The hospitalization allowance is limited to the number of days of surgery or infusion treatment during hospitalization in a public medical institution due to various diseases or accidental injuries within a coverage period.

  The coverage of hospitalization allowance is removed from the second level and above, and expanded to all public medical institutions, including township health centers.

   5. The number of days of benefit per hospitalization is limited to 90 days (the interval between two hospitalizations is not more than 30 days, which is regarded as one hospitalization). If the insured member is hospitalized multiple times, the accumulated benefit days are limited to 180 days.

   Note: In the hospitalization allowance insurance, “the interval between two hospitalizations is not more than 30 days, which is regarded as one hospitalization”.

   6. Added 4 yuan special health package guarantee responsibility.

   Added male and female specific disease protection and accidental disability protection. The maximum guarantee is 4000 yuan.

   2. Precautions for participating in the insurance and the content that needs further clarification

   1. Units can use union funds to participate in uniform insurance for employees.

  2. The insurance payment time is: March 12 to April 30, 2018. The online insurance system will be closed after the expiry date and no more procedures will be processed.

  3. The payment is divided into two methods: transfer to public account and cash bank deposit. Cheque and cash payment are not accepted. For both security items, cash bank deposits must be issued with a certificate of unregistered bank account deposits and a copy of the handling person’s ID card.

  4. Electronic invoice issue: Invoices for hospitalization medical insurance can be automatically downloaded from the insured system; invoices for hospitalization allowance insurance can be downloaded online or delivered (automatically checked in the insured system).

  5. Inter-period issues: When continuously insured members have inter-period claims, they will be returned to the previous coverage period for compensation, and the medical expenses incurred in the next coverage period will no longer be accumulated. The validity period of inter-period hospitalization is 3 months, that is, you must apply for compensation within 90 days after discharge.

  6. ​​The exclusions of inpatient medical insurance items stipulate that the four types of diseases of waist, neck, joint inflammation, and skin are not reimbursed for non-surgical treatments such as acupuncture, massage, moxibustion, and Chinese medicine. The identification of the disease is based on the main diagnosis in hospitalized cases.

  7. The insured member's application for hospitalization insurance claims must be submitted within 90 days from the date of the final receipt or settlement voucher for medical expenses issued by the hospital (or medical insurance department). (Extend to half a year at most, but the validity period of inter-period hospitalization is 3 months, that is, you must apply for compensation within 90 days after discharge).

8. For remote inpatients who settle directly, please refer to the relevant requirements for reimbursement in "Hospitalization Medical Projects" or "Hospitalization Allowance Projects" for the submitted materials; for reimbursements to the medical insurance institution in the insured area, a copy of the hospitalization invoice and Weihai medical insurance must be submitted for reimbursement. Except for the overall settlement statement (which can be printed at the medical insurance office or printed on the Internet), other materials are consistent with the local medical reimbursement materials.

  9. If the insured member has other commercial insurance and needs to apply for medical expenses compensation, or the critical illness insurance needs to be reimbursed at the end of the year, please keep a copy of the information when submitting the required documents for subsequent reimbursement.

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