1. Adjustment of the population covered by personal medical insurance ① The coverage of the urban and rural residents’ medical insurance system includes all persons who should be insured (combined) by the existing urban residents’ medical insurance and the new rural cooperative medical insurance, that is, it covers all persons who should be insured by the basic medical insurance for employees except employees. All other urban and rural residents except protected persons. ② Migrant workers and people with flexible employment are required to participate in the basic medical insurance for employees in accordance with the law. Those who have difficulty can participate in the urban and rural residents' medical insurance in accordance with local regulations.
2. How to raise funds for personal medical insurance ① Adhere to multi-channel financing, continue to implement a financing method that mainly combines personal contributions and government subsidies, and encourage collectives, units or other social and economic organizations to provide support or funding. ② Reasonably divide the financing responsibilities of the government and individuals, and appropriately increase the proportion of individual contributions while raising government subsidy standards.
3. Determination of financing standards for personal medical insurance ① All localities must comprehensively consider the needs of urban and rural residents for medical insurance and critical illness insurance, and reasonably determine unified financing standards for urban and rural areas in accordance with the principle of balancing fund revenue and expenditure. ② In areas where there is a large gap between the individual payment standards of urban residents’ medical insurance and the new rural cooperative medical insurance, differential payment methods can be adopted to gradually transition within 2 to 3 years. ③The actual per capita financing and individual contributions after integration shall not be lower than the current level.
4. Personal medical insurance protection benefits ① Follow the principles of moderate protection and balance of revenue and expenditure, balance urban and rural protection benefits, and gradually unify the scope of protection and payment standards. ②The Urban and Rural Residents Medical Insurance Fund is mainly used to pay for inpatient and outpatient medical expenses incurred by insured persons. ③Stabilize the level of hospitalization protection, and keep the hospitalization expense payment ratio at around 75% within the scope of the policy. ④ Further improve outpatient coordination and gradually improve outpatient security levels. ⑤ Gradually narrow the gap between the payment ratio within the scope of the policy and the actual payment ratio.
Legal basis:
Article 23 of the "Social Insurance Law"
Employees shall participate in employee basic medical insurance, which shall be provided by the employer and employees in accordance with national regulations* **Same as paying basic medical insurance premiums. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other people with flexible employment can participate in the basic medical insurance for employees, and individuals must pay the basic medical insurance premiums in accordance with national regulations.
Article 24 of the "Social Insurance Law" The state establishes and improves a new rural cooperative medical system. The management measures for the new rural cooperative medical care shall be stipulated by the State Council.
Article 25 of the "Social Insurance Law" The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions and government subsidies. The government subsidizes the required personal contributions for people who enjoy the minimum living security, disabled people who have lost the ability to work, elderly people over 60 years old and minors from low-income families.
Article 23 of the "Full Text of the Social Insurance Law of the People's Republic of China"
Employees shall participate in employee basic medical insurance, which shall be provided by the employer and employees in accordance with national regulations*** Also pay basic medical insurance premiums. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other people with flexible employment can participate in the basic medical insurance for employees, and individuals must pay the basic medical insurance premiums in accordance with national regulations.
Article 24 of the "Full Text of the Social Insurance Law of the People's Republic of China"
The state establishes and improves a new rural cooperative medical system. The management measures for the new rural cooperative medical care shall be stipulated by the State Council.
Article 25 of the "Full Text of the Social Insurance Law of the People's Republic of China"
The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions and government subsidies. The government subsidizes the required personal contributions for people who enjoy the minimum living security, disabled people who have lost the ability to work, elderly people over 60 years old and minors from low-income families.