It's about you! Shandong serious illness insurance funding standard set 66 yuan per person per annum
the five departments of the human resources and Social Security Department of Shandong province and other departments jointly issued the notice on further improving the insurance system for the residents. In accordance with the economic and social development level of the province and the level of large disease insurance, the Provincial Department of social security of human resources and the Provincial Department of social security of human resources, in accordance with factors such as the level of economic and social development of the province and the level of insurance guarantee for large diseases, can calculate and determine the standard of financing for large disease insurance and carry out dynamic adjustment in principle. In principle, 10% left right of the residents' basic medical insurance fund raising standard is controlled. In 2018, the funding standard for serious illness insurance was determined to be 66 yuan per person per year.
implementation of differentiated standard for serious illness insurance. The standard of starting payment for serious illness insurance year is based on the annual disposable income of urban and rural residents released by the statistical department last year. In 2018, the cities of each district should take into account the operating conditions of the residents' health insurance fund and the disposable income of the residents. After actuarial, the standards of the onset and payment of major diseases insurance should be properly improved. In principle, it is not more than 20 thousand yuan, and the provincial department for human resources and social security is for the record. The standard of payment will remain unchanged for enjoying serious diseases and special drugs that are included in the scope of individual compensation and for the policy of helping the poor with a serious illness.
standardize the payment policy of large disease insurance. The coverage of the insurance for major diseases is connected with the basic medical insurance of the residents. In addition to the special medications that have been included in the scope of the individual compensation, all the current and effective basic medical insurance drugs catalogues, the catalogues of diagnosis and treatment items and the scope of medical service facilities are uniformly implemented in the state and the province, and the items of class B drugs, diagnosis and treatment projects and medical service facilities are carried out. The first part of the payment is not included in the coverage of serious illness insurance. To increase the proportion of payment and the maximum payment limit for the insurance of the disease, the proportion of the cost of the medical expenses under 200 thousand yuan (200 thousand yuan) and less than 300 thousand yuan was raised to 70%; the proportion of the personal medical expenses over 300 thousand yuan (300 thousand yuan) was raised to 75%; in a medical year, The maximum payment limit for major diseases insurance was raised to 400 thousand yuan.
improve the dynamic adjustment mechanism of serious illness insurance profit and loss. Since 2017, the income and expenditure of the major diseases insurance funds are calculated by the city of the District, and the surplus and losses of the major diseases insurance in the commercial insurance institutions are adjusted in time. In accordance with the opinion of the general office of the State Council on the comprehensive implementation of urban and rural residents' insurance for large diseases of urban and rural residents (2015) No. 57) and the general information of the office of the people's Government of the Shandong Provincial People's Government on the implementation of Document No. 57 of the State Office [2015] to improve the insurance system for the residents' disease insurance system (No. [2016] 37) (No. [2016] 37) It is necessary to further improve the dynamic adjustment mechanism for the profit and loss of serious illness insurance, and to specify the profit and loss ratio and the sharing method in the contract after negotiations with commercial insurance institutions.
establish a liquidation system for serious illness insurance funds. In accordance with the financial regulations of the social insurance fund management and insurance industry for serious illness insurance, we should establish and improve the liquidation system for serious illness insurance funds. The connection between serious illness insurance settlement and basic medical insurance settlement is based on the settlement date of basic medical insurance and insured persons. Since 2017, municipalities in various districts have been required to liquidate serious illness insurance funds every year. We should start 2014.amp and mdash2016 the unified liquidation work of the serious illness insurance funds in the whole province, and the specific liquidation and compensation measures shall be formulated separately.
raise the level of serious illness insurance management services. We should strengthen the coordination, guidance, supervision and management of the undertaking of serious illness insurance. Strengthening contract management, signing contracts for serious illness insurance by human resources and social security departments and commercial insurance institutions, and clarifies contractual responsibilities and obligations of both parties. In accordance with the contract, the medical insurance agencies should timely allocate the funds for the major diseases insurance, realize the information system docking and the timely exchange of relevant data, straighten out the payment and settlement process of funds, and realize the one-stop and one dragon service. We should establish a medical service supervision and coordination mechanism, increase the inspection of medical expenses in other places, and reduce unreasonable expenditures and illegal expenditures.
further strengthen medical cost control. Financial departments at all levels should strengthen the supervision of serious illness insurance funds, formulate financial burrows and accounting methods for serious illness insurance funds. The health planning department should accelerate the implementation of the comprehensive reform of public hospitals, explore the two price of drug purchase, restrain the high price of drug, strengthen the supervision of medical service behavior, strictly control the large prescription and excessive medical treatment, and prevent the irrational increase of medical expenses. The social security department of human resources should constantly improve the basic health insurance policy of residents, strengthen the reform of medical insurance payment mode, bring the insurance cost into the general control budget management of the designated medical institutions, increase the application of the medical insurance intelligence monitoring information system, and strengthen the supervision of the medical service behavior. The insurance regulatory authorities should strengthen the supervision and management of the commercial insurance institutions, strictly control the cost accounting, and reduce the operation cost of serious illness insurance. The
notice is effective from March 1, 2018 and will remain valid until December 31, 2019. The original policy contents of our province are inconsistent with the provisions of this circular, and shall be implemented in accordance with the provisions of this circular.