Shandong residents implement serious illness insurance, Ji'nan about 1100000 urban residents benefit
Ji'nan Times reporter Zhao Lu
recently, the provincial government office issued the "opinions on the work of developing residents' major diseases insurance". It is understood that since the beginning of this year, Shandong has fully implemented the system of residents' serious illness insurance to protect the insured people who participate in the basic medical insurance for residents. According to local regulations, the newborns will attend the basic medical insurance procedures for residents, and enjoy basic medical insurance and serious illness insurance benefits from the date of birth. It is understood that before the new rural cooperative medical system was not included, the insured population of basic medical insurance for residents reached about 1100000.
it is understood that residents' serious illness insurance is compensated by the amount of medical expenses. The medical expenses of the residents in a medical year (including the chronic disease of the outpatient) are insured. After the compensation of the basic medical insurance of the residents, the cumulative cost of the cumulative burden of the individual exceeds the standard for the onset and payment of the residents' major illness insurance, which is compensated by the residents' disease insurance. In 2014, the range of medical expenses for medical treatment of large disease insurance was carried out according to the combined urban basic medical insurance and the original new agricultural cooperation catalogue, the catalogue of diagnosis and treatment items and the catalogue of service facilities.
the standard of residents' serious illness insurance payment is determined according to the annual disposable income of the residents in our province in the previous year. The actual payment ratio is not less than 50%. Our province will also set up a dynamic adjustment mechanism for payment standard, and adjust it in time according to the criteria of raising funds and the change of disposable income of residents. The specific compensation scheme will be determined through open tender or negotiation. On this basis, the civil affairs, health and family planning departments will give some relief to the relief objects again.
reporter learned that in 2014, the standards for the onset and payment of medical insurance for the residents were 10 thousand yuan, and the compliance costs of the individual above the standard above were compensated according to the amount of medical expenses. At the specific level, the personal burden of medical fees under 10 thousand yuan and more than 100 thousand yuan is not less than 50% of the compensation, more than 100 thousand yuan is not less than 60% of the compensation, the maximum compensation limit of 200 thousand yuan in the individual year.
the residents' insurance funds will be allocated from the basic health insurance fund of the residents, and the offices of the residents are allocated to the commercial insurance institutions according to the regulations. In 2014, the standard of raising residents' serious illness insurance was 32 yuan per person. It is also understood that serious illness insurance will be implemented at the provincial level, and the unified policy of the whole province should be unified bidding or negotiation.
standard
10 thousand yuan
payment ratio
personal burden compliance medical fee less than 100 thousand yuan less than 50% yuan compensation, more than 100 thousand yuan The compensation
2014 is 32 yuan
(background data)
basic medical insurance including basic medical insurance for urban workers and medical insurance of urban residents. In February this year, the urban and rural residents' medical insurance merged formally, and the new rural cooperative medical system and the urban residents' medical insurance were integrated into the basic medical insurance for urban and rural residents.
[account]
there are more than
the health insurance of a large disease. Generally speaking, people who participate in medical insurance are low, and if they get a serious illness, it will return to the poor due to disease and disease. The cost beyond the top line is still a great burden. Experts in the field of social security analysis, the imminent implementation of the serious illness insurance system is good news for residents insured. Suppose a resident medical insurance participant is hospitalized for illness. Before the implementation of the medical insurance, the maximum can be reported to 196 thousand yuan by the top line, assuming he has not been able to report 300 thousand yuan, which needs to be paid for his own money. And after the implementation of the disease insurance system, the 300 thousand yuan, the removal of 10 thousand yuan starting line, remaining 290 thousand yuan can continue to reimburse, of which 90 thousand yuan is reimbursed in proportion to 50%, can get 45 thousand yuan and 200 thousand yuan in accordance with 60% reimbursement, can be 120 thousand yuan. A total of 165 thousand yuan will be reimbursed than before.
reporter Zhao Yunlong
since 2015, residents' major disease insurance no longer implements 20 kinds of major diseases compensation policy
next year, how to make the unification of major diseases insurance in accordance with the amount of medical expenses to compensate
New NCMS major diseases Medical Insurance? At the same time, Shandong issued a transitional policy for it.
it is understood that rural residents have white blood and children with congenital heart and terminal renal disease, breast cancer, cervical cancer, heavy mental illness, AIDS opportunistic infection, multi drug resistant tuberculosis, chronic granulocytic white blood and cleft lip and palate, lung cancer, esophagus cancer, gastric cancer, type I diabetes, hyperthyroidism, and acute myocardial infarction Medical expenses for 20 major diseases, including cerebral infarction, colon cancer and rectal cancer, were compensated separately in 2014.
rural residents to cure the medical expenses of the above diseases, after the residents' basic medical insurance compensation, the individual burden of medical expenses over 10 thousand yuan of the compliance of the compliance of the 73% compensation, 10 thousand yuan under 17% compensation, the maximum compensation limit of 200 thousand yuan per year. The scope of the compliance medical expenses is still in accordance with the notice issued by the Ministry of health and other departments of the Ministry of health, such as the Department of the Ministry of health and other departments of the Ministry of health, on the publication of the medical expenses of the 20 major diseases of the new agricultural cooperation and large diseases insurance (Trial). Urban residents suffering from 20 major diseases are also carried out in accordance with the above provisions.
this year, the financing of large disease insurance is rated at 32 yuan per person. What if the fund gap is generated by the policy transition? Shandong stipulates that the financial gap of large disease insurance over 32 yuan exceeding the financing standard caused by the medical insurance policy of major diseases in 2014 is determined by the Provincial Association hall and the Provincial Department of finance. The government is responsible for CO ordinating the residents' basic medical insurance. Since 2015, residents' serious illness insurance will no longer carry out the 20 major compensation policies for diseases, but will be compensated by the amount of medical expenses.