Recently, the General Office of the State Council issued the "Guiding Opinions on Improving the Long-term Mechanism for Participation in Basic Medical Insurance," which introduced new regulations on some of the policies for participation in China's basic medical insurance, involving eligibility, financing standards, and benefit provisions. Particularly, new flexible regulations have been made regarding the waiting period for participation in urban and rural resident medical insurance. Two significant time points are three months and six months.

Firstly, individuals participating in urban and rural resident medical insurance who have not paid within the concentrated payment period or have not maintained continuous coverage will be subject to a certain waiting period before they can enjoy medical insurance benefits.

For many years, our country's social security and medical insurance departments have been striving to expand the coverage of urban and rural resident medical insurance and have set up many preferential policies for everyone.

For example, in April this year, the Beihu District of Chenzhou City, Hunan Province, announced that the supplementary payment work for urban and rural resident medical insurance would be extended to May 31st, and the medical insurance reimbursement benefits would be enjoyed within 30 days after the payment is received. That is to say, the benefit waiting period is only one month.

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In cities like Qingdao, when I insured my second child, I faced the issue of whether to make up the medical insurance payment for that year. If I did not make up the payment, the benefits would start from January 1st of the following year. If I made up the payment, I could enjoy the benefits continuously. It is possible to make up the payment at any time within six months from the date of birth, and enjoy the medical insurance reimbursement policy from the date of birth.

In fact, there are many similar situations like the one mentioned above, mainly to enhance everyone's enthusiasm for participation. However, due to the lenient make-up payment policy, some people have indeed thought about waiting until they have health problems before participating. This situation is indeed unfair to those who participate and pay on time every year.

This time, the national optimization of the participation policy does reflect a guidance for people to pay on time. As long as the payment is not made within the concentrated payment period or there is an interruption in payment, a waiting period of not less than three months will be set from 2025.

For example, ①The payment period for urban and rural resident medical insurance in 2025 is generally from October to December. If the payment is not made in time and is paid in January 2025, then the actual reimbursement will start in April 2025. ②If the urban and rural resident medical insurance for 2024 is not paid, even if it is paid during the concentrated payment period of 2024, it will also have to wait until April 2025 to enjoy the medical insurance reimbursement.

Secondly, how is the number of months in the medical insurance waiting period calculated? The national regulation sets a minimum of three months, with no upper limit specified. According to the regulations, for each year that urban and rural resident medical insurance is not paid, the medical insurance waiting period will be increased by one month on the basis of three months.Like the second scenario mentioned above, if you do not make up the payment for the medical insurance in 2024 (only interrupting for this one year), you may only be able to enjoy the medical insurance reimbursement from May 1, 2025, with a waiting period for benefits from January 1 to April 30.

What if the interruption lasts for 10 years? It would be 13 months. For 40 years, it would be 43 months. Of course, the implementation of the urban and rural resident medical insurance has not been around for such a long time.

Generally, policies are not retroactive unless there are special provisions. This means that people will generally start from 2025, and if the interruption in 2025 is not made up, it will extend by one month, while payments made in 2024 and before will be executed according to the previous regulations.

Additionally, some places may set a cap on the medical insurance waiting period. For example, the longest waiting period might be 9 months, 10 months, or 12 months, as waiting for too long may deter people from enrolling. Especially for the labor force population that has not participated in employee medical insurance or urban and rural resident medical insurance, the specific determination time should be decided by local policies.

Thirdly, the repair of the medical insurance waiting period. If there is indeed an excessively long waiting time for medical insurance, policyholders can repair the waiting period by making up the medical insurance payments for the interrupted period. The principle is that for each additional year of payment made up, one month is reduced.

For example, after an interruption of one year, if you make up the payment for that year's resident medical insurance, the waiting period is reduced from 4 months to 3 months.

However, to prevent long-term interruptions, if there is a continuous interruption for more than 4 years, the repaired medical insurance waiting period should not be less than 6 months.

Overall, the new regulations on the waiting period for urban and rural resident medical insurance are conducive to guiding people to pay on time during the centralized payment period each year, and also enhance the attractiveness of employee basic medical insurance. It has a very positive significance for the development and improvement of China's medical insurance system. #Top Headline Creation Challenge# #Medical Insurance Waiting Period#