Notice on the Re-raising of the Maximum Payment Limit and Other Related Treatments of Liaocheng City's Urban Basic Medical Insurances

Liaocheng City Medical Insurance Business Office 2011-8-1 11:28:49Social Development [2011] No. 11

Counties (cities, districts) Human Resources and Social Security Bureau (Bureau of Labor Security), Development Zone Management Committee Political and Labor Department, the municipal departments, insured units, participants:

In order to implement the Shandong Provincial Bureau of Social Insurance “on the issuance of” 2011 Shandong Province social insurance management and management services work points “notice” (Lu social security hair [2011] No. 1) and Liaocheng City People's Government Office “on the issuance of Liaocheng City Medical and Health System Reform in 2011 the key work of the arrangement of the notice” (Liaocheng City Government Office issued [2011] No. 48) documents, and to further improve the Urban basic medical insurance level, reduce the burden of insured persons to seek medical treatment, convenient for patients to seek medical treatment, combined with the operation of the city's basic medical insurance fund, the city's urban residents are now the maximum payment limit of the medical insurance fund, the urban basic medical insurance fund to pay the proportion of the following adjustments:

I. Increase the maximum payment limit of urban residents' basic medical insurance fund
 According to the per capita disposable income of Liaocheng city residents in 2010, the maximum payment limit of the basic medical insurance fund for urban residents will be adjusted, and the maximum payment limit will be adjusted to 80,000 yuan for adult residents and 120,000 yuan for minor residents in a natural year.
 Adjustment of the payment ratio of the basic medical insurance fund for urban employees
 After the adjustment, the payment ratios for medical expenses incurred by insured workers during hospitalization and included in the scope of payment of the integrated fund when settling the bill at each designated hospital are as follows:
    Payment of urban workers' integrated fund and relief fund by grade 
Stage Stage interval First-class hospitals % Second-class hospitals % Third-class hospitals   
              In-service retirement In-service retirement In-service retirement   
1 Starting standard -20000 87% 90% 85% 88% 80% 83   
2 20000.01 - 50000 89% 92% 87% 90% 82% 85   
3 50000.01 - 70000 91% 94% 89% 92% 84% 87   
4 70000.01-250000 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90   
5 250000.01- 35% 35% 35% 35% 35% 35% 35% 35% 35% 35 
  Adjustment of urban residents' basic medical insurance fund payment ratio
 After the adjustment, the medical expenses incurred by the insured residents during their hospitalization and included in the scope of payment of the integrated fund will be paid as follows at the time of settlement by the designated hospitals:
  Grades of payment by the integrated fund for adult residents 
Stage Stage interval first-class hospitals % second-class hospitals % third-class hospitals %   
1 Starting standard - 30000.00 65% 60% 55   
2 30000.01-80000.00 70% 65% 60 

Minor residents of the Coordinated Fund to pay the graded situation 
Grades Grades interval First-level hospitals % Second-level hospitals % Third-level hospitals %   
1 Starting standard -30000.00 75% 70% 65   
2 30000.01-120000.00 80% 75% 70% 
  Adjustment of the proportion of outpatient treatment of chronic diseases paid by the Employees' Health Insurance Fund
  For outpatient chronic disease patients who are included in the scope of payment of the fund, the payment ratio of medical expenses incurred in outpatient clinics in accordance with the regulations is 85% for active employees and 90% for retirees. The payment ratio for qualified examination expenses incurred outside Liaocheng city area shall be implemented according to the above standard; the payment ratio for qualified drugs and treatment expenses shall be reduced by 5% compared with that in the city.
  V. Linqing City, Chiping County, Dong'a County and Guan County, which are included in the municipal coordination of urban workers' medical insurance, will follow the above standards; counties not included in the municipal coordination may refer to the above standards.
  This notice is effective from August 1, 2011 onwards.

                               July 29, 2011