since June 1st this year, Ji'nan will fully implement the long-term health care insurance for employees. What will be enjoyed by the insured? Recently, Jinan City People's social bureau announced the implementation of long-term medical care insurance for workers in Ji'nan (Trial Implementation), and openly consulted the society. According to the implementation measures, the insured will be able to apply for long-term medical care insurance benefits if they have been in bed for over six months due to illness or disability.
application conditions: long stay in bed, life can not take care of
it is understood that all the staff participating in the basic medical insurance of Ji'nan workers, all participate in the long-term medical care insurance of the staff and workers. After being assessed, they will enjoy the long-term care insurance benefits from the date of approval.
the insured person can enjoy the treatment of long-term medical care insurance under what circumstances? The fifth article of implementation stipulates that the insured has been in bed for more than six months for the reasons of disease, disability and so on. The life can not be taken care of, the condition is basically stable, and the score of
is evaluated according to the daily living ability assessment scale. It was noted that the daily life capacity assessment scale included items, evaluation criteria and scores, including 10 items, including eating, bathing, dressing, dressing, controlling stool, controlling urine, toilet, bed chair transfer, walking, up and down stairs and so on. The total score was 100 points.
treatment enjoyment: can apply for special care, hospital care and home care
according to the implementation methods, the insured can apply for medical care, nursing care and home care according to different circumstances (for short, special care, hospital care and home care, respectively).
fifth regulations stipulate that the application of special care should be one of the following conditions: end-stage malignant tumor (cachexia); long term retention of tracheal tube, external drainage tube, fistula tube, deep vein catheterization, and other pipes (excluding nasal feeding tube and catheter) for a long time, and need to treat the wound regularly; It depends on ventilator and other medical devices to maintain vital signs. All kinds of serious irreversible diseases and paralysis and paraplegia require long-term hospitalization.
application for nursing and home care should be in accordance with one of the following conditions: to meet the requirements of special application; long-term retention of nasal feeding tube and urethral catheter; long-term nonunion of fracture, combined with other chronic diseases; suffering from the following chronic diseases: Parkinson's disease (severe), plants, and severe rheumatoid arthritis (multiple stages) Severe deformation of joints or other severe chronic osteoarthrosis affects the movement and retention of the body.
cost settlement:
it is understood that the long-term care insurance funds are solved through the basic medical insurance fund, financial aid funds, public welfare gold and personal contributions and other social groups and individual contributions from enterprises, units, charities and other organizations. The funds required for long-term care insurance are based on the number of insured employees for basic medical insurance, which is raised by a standard of 115 yuan per person per year. Among them, the finance is 5 yuan per person, the welfare lottery public welfare fund is 10 yuan per person, the worker basic medical insurance co-ordination fund is 100 yuan each person (temporarily does not implement personal account transfer payment). The fourteenth provision for implementing
stipulates that the long term medical care insurance cost shall be managed by "fixed quota, overspending and no subsidy".
according to the form of medical care service, the medical qualification and service ability of designated health care institutions, the standard of contracting is determined separately. According to the following standards, the total cost per day is 50 yuan, 60 yuan for family care and 200 yuan for special nursing.