Shanghai workers’ community insurance started in June, and the payment standard was adjusted.

People’s Online Haihai, May 26 (Ge Junjun) The reporter learned from the Shanghai Workers’ Security Mutual Aid Association that the "Shanghai Workers’ Mutual Aid Project 2020" and the "Shanghai Retired Workers’ Hospitalization Supplementary Medical Mutual Aid Plan" will be launched in 2020. Compared with the past, the payment standards of the two guarantees have been adjusted, and the protection intensity has been greatly improved. Among them, retired employees who plan to stay in hospital can get a maximum of 100,000 yuan. In addition, in the event of hospitalization, the insured person of the plan does not need to apply for payment, and the retirement hospitalization security fund will be directly included in the pension account of the insured employee.

"Shanghai Workers’ Mutual Assistance Project 2020" Basic Insurance for Community Participation

Target: qualified flexible employees

Flexible employees refer to self-employed people who have legitimate economic income, individual industrial and commercial households without employees, part-time employees who have not participated in basic old-age pension and medical insurance in the employer, and other flexible employees.

The basic insurance project of "Shanghai Workers’ Mutual Assistance Project 2020" is composed of three kinds of insurance: basic insurance for hospitalization, basic insurance for special serious illness and basic insurance for accidental injury. When the flexible employees are insured, they can choose one of the three guarantees, or they can also be insured at the same time.

The basic insurance for insured hospitalization needs to be met: men under 60 years old and women under 55 years old, who pay the basic medical insurance premium at a rate of 14%, are flexible employees who are covered by the basic medical insurance for employees in Shanghai and enjoy on-the-job medical insurance benefits. The basic guarantee fee is 120 yuan/person. The basic guarantee period is one year, from 0: 00 on June 2nd of that year to 24: 00 on June 1st of the next year. The cumulative maximum payment of security fund is 110,000 yuan, including 100,000 yuan for hospitalization basic security and 10,000 yuan for additional security for illness and death.

The basic guarantee for participating in special serious illness needs to meet: flexible employees under 60 years old for men and 55 years old for women. The basic guarantee fee is 55 yuan/person. The guarantee period of basic guarantee is one year, from 0: 00 on June 2nd of that year to 24: 00 on June 1st of the next year. The maximum guarantee for basic security is 20,000 yuan.

The basic insurance for accidental injury should meet the following requirements: flexible employees under the age of 60 for men and 55 for women. The basic guarantee fee is 15 yuan/person. The basic guarantee period is one year, from 0: 00 on July 1st of that year to 24: 00 on June 30th of the next year. The cumulative maximum payment of the security fund is 30,000 yuan, of which the maximum basic security guarantee for accidental injury is 20,000 yuan and the maximum additional security guarantee for accidental fire is 10,000 yuan.

People with flexible employment can apply for community insurance in June by presenting their ID cards to the service points (community affairs acceptance service centers) of various trade unions in this city.

"Retirees’ Hospitalization Supplementary Medical Mutual Assistance Scheme" will be insured in the community in 2020.

Target: eligible retired workers

"Retirement hospitalization security plan" is a supplementary medical security project undertaken by the Municipal Workers’ Security Mutual Aid Association to coordinate with the reform of Shanghai workers’ medical insurance system. It is mainly based on unit insurance and supplemented by community insurance, and helps insured retirees reduce the burden of hospitalization medical expenses through mutual aid mechanism.

In 2020, the community participants of the "Supplementary Medical Mutual Assistance Plan for Retired Employees" are social retirees without units who enjoy the treatment of "Shanghai basic medical insurance for employees" and retirees who are not organized to participate in the insurance.

The payment standard is divided into the following categories: those who are insured in the community, those who are insured for the first time within one year after their new retirement, and those who are insured again within one year after their insurance is broken. The payment standard is 365 yuan/person per year; Among the insured persons in the community, those who have retired for more than one year or have been out of insurance for more than one year (not more than two years) calculated from 2013, the payment standard is 730 yuan/person; From 2013 onwards, the payment standard for those who have retired for more than two years without insurance or have been out of insurance for more than two years is 1095 yuan/person. Among them, the year of uninsured or interrupted insurance does not enjoy the guarantee treatment.

The protection period of the plan is one year or less. Specifically, those who participated in the insurance in June: the guarantee period is one year, from 0: 00 on June 2 of that year to 24: 00 on June 1 of the next year. If a new social retiree is insured for the first time within 2 months after retirement, the guarantee period shall be from 0: 00 on the 2nd of the current month to 24: 00 on June 1st within the first anniversary.

During the guarantee period, if the insured person is hospitalized, hospitalized in the emergency observation room where the medical expenses are settled according to the hospitalization standard, seriously ill out-patient treatment and family sickbed treatment, the Shanghai Workers’ Security Mutual Aid Society will reimburse the medical expenses within the scope of the overall fund (or additional fund) at a rate of 50%-70%. Individuals can receive a maximum of 100,000 yuan in accumulated security.

Where the retired employees who participate in the "Retirement Hospitalization Security Plan" are hospitalized, there is no need to apply for payment. The Municipal Occupational Insurance Association will directly transfer the retirement hospitalization security fund to the insured employees’ pension bank account through mutual assistance security database and information data of social security departments and medical insurance departments. If you don’t want to wait for automatic payment, retired employees can also APPly online for hospitalization on the "with the application" app, WeChat "with the application" applet and Alipay applet. Retired workers who need SMS notification can go to the nearest street and town affairs acceptance center to register their mobile phone numbers.

From June 1st to June 30th, all the retired employees in this city who meet the conditions of "Retirement Hospitalization Plan" can apply for insurance at the windows of the community affairs acceptance centers in this city nearby. This year, they can also apply for "no meeting" through the mobile phone "with the application" APP, WeChat "with the application" applet and Alipay applet, and retired employees do not need to submit the original ID card and pension verification form, so as to truly realize "zero materials, zero meeting and zero".

According to the reporter’s understanding, the following four situations still need to be handled at the window: namely, there is no pension bank account in this city; Receipt of sporadic medical expenses in the field; Receipt of medical expenses for family sickbed; Medical expenses receipts for medical insurance burden reduction and mental illness. When handling on site, it is necessary to improve the relevant materials provided, such as pension bank account, hospitalization receipt, discharge summary and other materials.