Notice of Shangluo Municipal Bureau of Taxation of Shangluo City, State Taxation Administration of The People’s Republic of China on the payment of basic medical insurance for urban and rural resident

First, the insured object

In addition to the basic medical insurance for employees (hereinafter referred to as employee medical insurance), all urban and rural residents except those who enjoy other medical security systems in accordance with the regulations will implement the policy of holding residence permits, and primary and secondary school students and preschool children from other places will participate in residents’ medical insurance in their permanent residence. Encourage college students to participate in residents’ medical insurance at their school places, and implement relevant policies for participation.

Second, the payment standard

Individual payment standard, the implementation of the unified provisions of the province in 2024 residents medical insurance individual insurance payment standard, 400 yuan per person per year.

Three, special personnel insurance subsidy policy

The city’s residents’ medical insurance premiums are classified and funded by some insured individuals, and the insured funds are solved by financial funds and medical assistance funds. Insured persons who can enjoy multi-identity insurance subsidy have high or low subsidy standards and cannot enjoy the insurance subsidy policy repeatedly.

(a) poor people, orphans (including the fact that no one is raising children) to give full funding, the funds from the medical assistance fund.

(II) The minimum target is subsidized according to the quota of 240 yuan/person, and the insured funds are paid from the medical assistance fund. After enjoying the subsidy, the individual bears part of the 160 yuan/person and the insured pays it by himself.

(III) The poverty-stricken population identified by the agricultural and rural departments and the poverty-stricken population in rural areas that are easy to return to poverty (unstable poverty-stricken households, marginal poverty-stricken households, and sudden severe hardship households) are given a fixed subsidy according to 240 yuan/person. After enjoying the subsidy, some 160 yuan/person borne by individuals shall be paid by the insured.

(IV) The individual payment subsidy for eligible rural only-child parents and children under the age of 18 in this Municipality shall be implemented in accordance with the Notice on the Measures for Individual Payment Subsidies for Rural Only-child Parents in Shaanxi Province to Participate in Urban and Rural Residents’ Medical Insurance (No.36 [2023] of Shaanxi Wei Population).

Four, the insured payment and treatment to enjoy time

The centralized payment period of medical insurance for residents in the city is from September 26, 2024 to December 20, 2024. If it is necessary to extend or shorten the time of centralized payment due to special circumstances, the tax department shall notify the society after consultation with the medical insurance department, and the city shall implement it uniformly.

In 2024, residents’ medical insurance contributions will be paid back, from January 1, 2025 to March 31, 2025.

(A) the general staff insurance payment policy

The general insured shall pay the residents’ medical insurance premium during the centralized payment period, and the residents’ medical insurance benefits will be enjoyed from January 1, 2025 to December 31, 2025 after payment. Pay medical insurance premiums for urban and rural residents during the overdue period, and set a waiting period of 3 months for fixed treatment. Those who fail to pay the insurance premium in the centralized payment period or the supplementary payment period shall not enjoy the residents’ medical insurance benefits in the insured year.

(two) some special personnel insurance payment policy.

1. Workers’ medical insurance personnel

Those who need to participate in the residents’ medical insurance in the current year after the interruption of their medical insurance during the employee’s medical insurance period should apply for the registration of residents’ medical insurance in time after suspending the original insurance relationship. After the payment is completed according to the individual payment standard uniformly stipulated by the whole city, the treatment enjoyment period starts from the next month after participating in the residents’ medical insurance payment to December 31 or the date of change again.

2. Newborns

(1) From January 1, 2025, within 90 days after the birth of a newborn, the guardian shall register with the medical insurance agency at the place where the newborn is registered or where he lives, and pay the medical insurance premium of the residents in the year of birth. The treatment period is from the date of birth to December 31 of the year of birth; If the newborn fails to pay the medical insurance premium of the residents in the year of birth within 90 days, he can pay the insurance premium in accordance with the unified individual payment standard of the whole city in that year. After the payment is completed, the treatment period is from the month following the payment in the year of birth to December 31.

(2) The date of birth of the newborn is less than 90 days from December 31st of that year. If you enjoy the medical insurance benefits of the year of birth, you must pay the medical insurance premiums of the residents of the year of birth within 90 days after birth, and the period of enjoying the benefits is from the date of birth to December 31st of that year; If you enjoy the medical insurance benefits for the second year after birth, you must pay the medical insurance premium for the second year after birth within 90 days after birth, and the treatment period is from January 1 to December 31 of the following year; Failing to pay the corresponding annual residents’ medical insurance premium within 90 days, it shall be implemented according to the relevant provisions of the general staff’s insurance payment and enjoyment of treatment.

(3) If the newborn dies after birth, and the guardian pays for the insurance within 90 days from the date of birth, the medical expenses incurred after birth shall be reimbursed according to the policy.

3. College students

(1) In those years, college students who have enrolled and new college students are based on their school status and take the school (campus) as the unit. After paying the insurance premium, they will enjoy the residents’ medical insurance benefits from the date of payment completion. If you are a person who enjoys government-funded insurance, you can choose to participate in the school registration or identity recognition, and enjoy the residents’ medical insurance benefits according to regulations.

(2) The insured college students who graduated this year in the insured year will enjoy the medical insurance benefits in Shangluo until December 31st of the current year. After graduation, those who participate in employee medical insurance or move out of Shangluo City or move into other cities shall be handled in accordance with relevant regulations.

4. Others

(1) Special personnel who are not insured during the centralized payment period or the supplementary payment period, and need to be insured after the start of the treatment enjoyment period, and the policy allows them to be insured, after completing the insurance payment according to the individual payment standard stipulated by the province, the treatment enjoyment period is counted from the month after the residents’ medical insurance payment.

(2) The insured persons who enjoy classified funding for individual contributions should be insured during the centralized payment period. Those who are not insured during the centralized payment period do not enjoy the classified funding policy for individual contributions, but can enjoy the original medical insurance benefits after paying according to the individual payment standards stipulated by the province. The treatment enjoyment period is counted from the month after the residents’ medical insurance payment.

(3) Persons who change their identities dynamically during the insured year will enjoy the corresponding medical insurance benefits for their new identities after their identity changes from the next month. Persons who change their identity during the hospitalization period of different months shall be hospitalized in accordance with the principle of benefiting the treatment of the insured.

(4) Establish an incentive mechanism for serious illness insurance benefits for residents’ medical insurance continuous insured personnel and zero reimbursement personnel. Since 2025, the maximum payment limit for serious illness insurance will be reduced by 3,000 yuan for those who have been insured again; For the insured who have participated in the residents’ medical insurance for 4 years in a row, the maximum payment limit for serious illness will be increased by 3,000 yuan for each consecutive year. For the residents’ medical insurance insured with zero reimbursement from the fund in that year, the maximum payment limit of serious illness insurance will be increased by 3,000 yuan in the following year. Continuous insurance incentives and zero reimbursement incentives, the total increase does not exceed 20% of the city’s major illness insurance capping line. After the residents are reimbursed for serious illness and use the incentive amount, the zero reimbursement incentive amount accumulated in the previous period will be cleared. If you are insured again after the insurance is broken, the number of years of continuous insurance will be recalculated.

(5) Since 2025, except for special groups such as newborns, the waiting period for fixed treatment after enrollment will be set at 3 months for those who have not been insured during the centralized enrollment period of residents’ medical insurance; Among them, for those who have not been insured continuously, the waiting period of variable treatment will be increased by 1 month on the basis of fixed treatment waiting period in principle, and the insured can repair the waiting period of variable treatment by paying fees, which can be reduced by 1 month for each additional year. For those who have been paid continuously for 4 years or more, the sum of fixed treatment waiting period and variable treatment waiting period after repair is not less than 6 months in principle. The payment standard is implemented according to the individual payment standard of urban and rural residents in the city.

V. Insurance registration

The tax department has no information about the newly-added personnel to be insured, or those who need to adjust their insurance payment places in the new insurance year. They must hold the valid proof of their household registration, the residence permit issued by the public security department of their long-term residence, and their valid ID cards (those with special personnel identity must carry relevant identification certificates) to go to the medical insurance agency where their household registration or residence permit is located for insurance registration.

Sixth, payment channels

(1) "Shaanxi Taxation" WeChat WeChat official account; "Shangluo Taxation" WeChat WeChat official account;

(2) Rural Credit Bank: all business outlets, self-service equipment, mobile banking, online banking, e-terminal for helping farmers, and Shaanxi Rural Credit WeChat WeChat official account;

(3) Qinnong Bank: all business outlets, self-service equipment and e-terminals for helping farmers;

(4) Alipay: the social security section of the Citizen Center and the "Shaanxi Social Security Payment" applet (you can check the payment certificate of my real name registration after payment through all channels);

(5) China UnionPay: China Unionpay Quick Pass APP (Shaanxi Social Security Payment); "Shaanxi social security payment" WeChat applet, WeChat city service-service hall-social security;

(6) Everbright Bank: WeChat city service, "social security cloud payment" APPlet, cloud payment app, and mobile banking;

(7) China Construction Bank: all business outlets, mobile banking, smart teller machines, Yunongtong financial service points, code scanning payment and Qin clerk APP；;

(8) ICBC: all business outlets, mobile banking, smart terminals of outlets, "ICBC Shaanxi Branch" WeChat WeChat official account, and ICBC e-payment QR code scanning;

(9) Agricultural Bank: all business outlets, mobile banking and scanning code payment;

(10) Bank of China: all business outlets and mobile banking;

(11) China Merchants Bank: Mobile banking.

Seven, payment bills

(1) If the payer pays the basic medical insurance premium for urban and rural residents through various channels of financial institutions, the payment shall be based on the electronic order payment voucher, the small ticket printed by self-service equipment or the Special Note for Social Insurance Fee Payment for Urban and Rural Residents in Shaanxi Province printed on the bank counter.

(2) If the payer pays the basic medical insurance for urban and rural residents through Shaanxi Tax WeChat WeChat official account, UnionPay "China Unionpay Quick Pass", Everbright Bank WeChat applet "Social Security Cloud Payment" and Alipay, the payment voucher of the electronic order can be used as the basis for payment. If paper payment bills are really necessary, please pay through the bank counter and obtain special payment bills, or go to the tax service hall of the competent tax department of the insured place to print the tax payment certificate 3 days after the payment is completed.

(3) Online acquisition method of payment voucher: After the payer completes payment through any channel for 3 days, he can select the social security payment voucher for urban and rural residents to print through Alipay-Citizen Center-Social Security; Or search "Shaanxi Electronic Taxation Bureau" and select "Certificate of Tax Payment (Fee) for Social Insurance Fees of Urban and Rural Residents" for printing.

Eight, medical insurance refund

After the insured person successfully pays the fee, he will enter the treatment enjoyment period (after January 1, 2025), and the individual payment will not be returned. Before the treatment enjoyment period, due to death, repeated payment, participation in employee medical insurance or participation in residents’ medical insurance in other overall planning areas, the personal refund can be handled at the same time when the relevant residents’ medical insurance participation relationship is terminated before the treatment enjoyment period begins.

The application for refund of the insured shall be submitted by the payer to the tax department of the original place of payment, and the refund shall be completed by the medical department of the original place of payment after the final approval of the medical department of the original place of payment.

IX. Inter-annual settlement

Cross-year medical insurance settlement for urban and rural residents who are insured continuously in the overall planning area shall be handled in accordance with the annual settlement policy of the discharge time of insured patients.

Cross-year and cross-regional insured inpatients shall be settled separately according to the settlement policies of different insured areas in the natural year.

notice is hereby given (that)

Shangluo Taxation Bureau of State Taxation Administration of The People’s Republic of China

Shangluo medical security bureau

September 25, 2024

Policy interpretation:

@ Shangluo people, the medical insurance payment for urban and rural residents began in 2024!

How to pay residents’ medical insurance fees for their families with employee medical insurance personal accounts?

Ten Questions and Ten Answers on Basic Medical Insurance for Urban and Rural Residents in Shangluo City