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国家医保局 财政部 国家税务总局关于加强和改进基本医疗保险参保工作的指导意见

发布时间: 2019-10-10     选择阅读字号: [ ]     阅读次数: 0

国家医保局  财政部  国家税务总局关于加强和改进

基本医疗保险参保工作的指导意见

医保发〔2020〕33号

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一、总体要求

(一)指导思想

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(二)总体原则

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(三)主要目标

SHENRUSHISHIQUANMINCANBAOJIHUA,ZI2021NIANCANBAONIANDUQI,QUANGUOCANBAOXINXISHIXIANHULIANHUTONG、DONGTAIGENGXIN、SHISHICHAXUN,CANBAOXINXIZHILIANGMINGXIANTISHENG;DAO2025NIAN,JIBENYIBAOCANBAOLVWENZHONGYOUSHENG,GUANLIbbinGUANFANGSHUIPINGMINGXIANTISHENG,QUNZHONGHUODEGANMANYIDUCHIXUZENGQIANG。

二、主要任务

(一)合理设定参保扩面目标

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(二)落实参保缴费政策

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(三)做好跨制度参保的待遇衔接

CANBAORENYILIANXU2NIAN(HAN2NIAN)YISHANGCANJIAJIBENYILIAOBAOXIANDE,YINJIUYEDENGGERENZHUANGTAIBIANHUAZAIZHIGONGYIBAOHEJUMINYIBAOJIANQIEHUANCANBAOGUANXIDE,QIEZHONGDUANJIAOFEISHIJIANBUCHAOGUO3GEYUEDE,JIAOFEIHOUJIKEZHENGCHANGXIANGSHOUDAIYU,QUEBAOCANBAORENDAIYUWUFENGXIANJIE。ZHONGDUANJIAOFEISHIJIANCHAOGUO3GEYUEDE,GETONGCHOUDIQUKEGENJUZISHENQINGKUANGSHEZHIBUCHAOGUO6GEYUEDEDAIYUXIANGSHOUDENGDAIQI,DAIYUXIANGSHOUDENGDAIQIMANHOUZANTINGYUANCANBAOGUANXI。

(四)有序清理重复参保

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(五)完善个人参保缴费bbin官方机制

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(六)加强财政补助资金管理

CHUDAZHONGZHUANXUESHENGRUXUEDANGNIANZHONGFUCANJIAJUMINYIBAOQINGXINGWAI,QITAZHONGFUCANJIAJUMINYIBAODE,XUZHONGZHIXIANGGUANJUMINYIBAOCANBAOGUANXI,BINGKOUJIANZHONGFUCANBAODANGNIANSHEJIDEGEJICAIZHENGBUZHUZIJIN。KUAZHIDUZHONGFUCANBAOQIELIANXUCANJIAZHIGONGYIBAOYINIANYISHANG(HANYINIAN)、CANBAOJIAOFEIZHUANGTAIZHENGCHANGDE,ZAIANBENYIJIANGUIDINGDEYUANZECHULIHOUKOUJIANZHONGFUCANBAODANGNIANJUMINYIBAODEGEJICAIZHENGBUZHUZIJIN。

三、加强改进重点人群参保缴费bbin官方

(一)建档立卡贫困人口。bbin官方按照精准到人要求,建立与扶贫、税务部门沟通机制,实行参保专项台账管理。按规定落实分类资助参保政策,确保动态参保、应保尽保。用好医疗保障信息系统脱贫攻坚运行调度模块、政策监测模块、督战模块,实时监测建档立卡贫困人口参保情况。为确保贫困人口稳定脱贫,贫困人口在职工医保和居民医保之间切换参保、转移接续参保关系时,不设等待期,不受居民医保规定缴费时间限制,在参保缴费后,即可享受相应待遇,医疗保障经办机构应及时暂停原参保关系。对在户籍地和居住地重复参加城乡居民医保的贫困人口,在征得本人同意后,确定需要保留的居民医保参保关系,应由本人作出书面承诺交医疗保障部门留存备案。

(二)大中专学生(含全日制研究生)。大中专学生原则上应在学籍地参加居民医保。若大中专学生为建档立卡贫困人口,可以选择在建档立卡贫困人口身份认定地参保。因入学形成的重复参保,学籍地医疗保障部门应依托全国信息平台参保功能模块,及时通知原参保地医疗保障部门终止参保关系。就业后形成的重复参保,就业地医疗保障部门应依托全国信息平台参保功能模块,及时通知原学籍地医疗保障部门暂停参保关系。具备条件的统筹地区在确保与学生原参保地医疗保险待遇无缝衔接的前提下,可将大中专学生参加居民医保的参保缴费期从学年调整为自然年度,作出调整的统筹地区学生在入学当年学籍地如发生医疗费用,采用异地就医直接结算报销费用,报销比例不受转外就医调减比例规定限制。

(三)新生儿。新生儿参保登记应使用本人真实姓名和身份证明。原则上新生儿出生后90天内由监护人按相关规定办理参保登记,自出生之日所发生的医疗费用均可纳入医保报销。对已使用父母姓名参保的新生儿,医疗保障部门应要求其监护人尽快更新信息。新生儿未在规定时间内参加居民医保的,按所在统筹地区具体规定执行。

(四)退役军人。军人退出现役后、由部队保障的随军未就业军人配偶实现就业后,按规定参加基本医疗保险并办理关系转移接续的,不受待遇享受等待期限制。已参加基本医疗保险的随军未就业军人配偶,在军人退出现役后,按所在统筹地区规定办理参保和关系转移接续。医疗保障部门要为相关人群业务办理提供便利,做好管理bbin官方。

(五)短期季节性务工人员及灵活就业人员。已经参加居民医保的短期季节性务工人员或灵活就业人员,在居民医保待遇享受期内参加职工医保,医疗保障部门应保证参保人享受新参加的医保待遇,暂停原居民医保待遇;参保人短期务工结束后,医疗保障部门及时恢复原居民医保待遇,确保待遇有效衔接。

(六)被征地农民。被征地农民在政府代缴医保费期间就业并参加职工医保的,医疗保障部门应做好参保关系转移接续,并及时暂停原居民医保待遇。

四、工作要求

(一)落实工作责任。各地要统一思想认识,强化责任担当,狠抓贯彻落实,确保让参保人获得更加满意的bbin官方。各级医疗保障部门应加强源头把关,注重全过程动态管理,确保参保人身份真实,保障合理待遇。要将参保计划完成情况、参保质量等工作纳入对省级医疗保障部门的绩效考核。各地可结合实际制定实施细则。

(二)加强宣传引导。进一步做好参保缴费宣传,创新宣传方式,拓展宣传渠道,对未参保人员实行精准推送式宣传,使群众全面了解医保政策和参保意义,调动群众参保缴费积极性,切实维护参保人合法权益。

(三)注重部门协作。bbin官方医疗保障、税务部门要优化完善信息系统和数据共享平台,对清理的重复参保信息妥善保管,以备后续查验。医疗保障、财政、税务部门要密切协作,加强沟通,稳妥有序做好参保工作,遇有重大情况和问题,及时向国家医保局、财政部、税务总局报告。

 

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链接: 《关于加强和改进基本医疗保险参保工作的指导意见》政策解读

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