In p>223, the time for urban and rural residents to participate in medical insurance payment has been fixed. After many years of participation, do you still have such questions? Ok, let's sit down and talk today. 1. Why did the individual contributions of residents' medical insurance rise? A: In 23, we only had to pay 1 yuan's medical insurance. Why do we need 35 yuan now? First of all, the sources of financing for residents' medical insurance fund mainly rely on individual contributions and state subsidies. In the past, 1 yuan's medical insurance was invested in 2 yuan, but due to the low level of financing, the medical insurance fund pool was small, which was mainly used to ensure the hospitalization treatment of the insured, with a maximum of several thousand yuan a year, and most outpatient clinics could not be reimbursed. It can be said that this kind of security level is very low and the security strength is very insufficient, which is difficult to meet the people's medical needs. In the past 2 years, with the economic development, the use of new drugs and new medical technologies, the enhancement of people's health awareness and the improvement of traffic conditions, the medical cost, medical price and medical insurance fund expenditure have been rising continuously. In order to adapt to this change, and constantly improve the security level of insured residents and expand the scope of medical insurance reimbursement, the state has made provisions for the individual insurance payment and financial subsidy standards to be appropriately raised year by year. By 222, the improvement of individual payment standards and the increase of state financial subsidies will make our residents' medical insurance fund pool more abundant. It is with such confidence that from 23 to 222, medical insurance has done a lot of reform work to solve the problem of "difficult and expensive medical treatment", not only including general outpatient service, chronic (special) outpatient service and serious diseases into the scope of medical insurance, but also increasing the maximum payment limit of funds within the hospitalization policy from several thousand yuan to several hundred thousand yuan now, and the reimbursement ratio has also increased from about 4%. Recently, according to the statistics of Guizhou Provincial Medical Insurance Bureau, from January to September, 222, there were more than 37 million residents participating in medical insurance in our province, and the fund expenditure for ensuring various medical treatments of residents participating in medical insurance was nearly 19.6 billion yuan. According to the fund-raising level in 23, calculated by individuals and national 3 yuan, our province can only raise about 1.1 billion yuan of residents' medical insurance fund, and the actual fund-raising will be nearly 18 times smaller than the actual expenditure, with a difference of 18.5 billion yuan. It can be seen that it is far from enough to guarantee the actual medical needs of the insured people in 222 with the financing level in 23. Therefore, in 35 yuan in 223, the payment standard is set scientifically in order to continuously improve the level of residents' medical insurance and reduce the burden of the insured people's medical expenses, so that everyone can truly enjoy the dividends released by the reform. Moreover, from the beginning of medical insurance, the state has been paying about twice the individual payment standard to make up for the gap risk caused by insufficient individual financing and medical insurance fund payment. It is reported that in 223, if you personally pay 35 yuan, the state will also provide subsidies according to the standard of not less than 61 yuan/year/person. Second, where did the money paid by residents' medical insurance individuals go? A: Actually, as I said just now, the medical expenses incurred by residents' medical insurance participants are mainly guaranteed by our medical insurance fund, which is mainly composed of individual contributions and state financial subsidies. Let's help you collect it and put it in a place called the medical insurance fund pool. According to Article 21 of the National Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, "the medical insurance fund is earmarked for special purposes, and no organization or individual may occupy or misappropriate it". Therefore, you don't have to worry, once you enter the medical insurance fund pool, the only purpose is to protect the outpatient and inpatient medical expenses of residents' medical insurance participants. If you didn't use this guarantee in the year of enrollment, first of all, congratulations, you have spent a healthy year. However, even if you didn't enjoy residents' medical insurance benefits in the year of payment, once other (her) insured persons incurred medical expenses that meet the requirements of medical insurance reimbursement, the medical insurance fund will start the payment guarantee mechanism for him (her) in time, which may greatly exceed the sum of individual contributions and state financial subsidies, which is the embodiment of the function of mutual assistance and economic assistance in medical insurance. Generally speaking, the insurance premium you pay will be used to protect the patients who are also insured with you. Therefore, in an insured year, the insured who meets the treatment of residents' medical insurance reimbursement will be guaranteed by mobilizing funds from the fund pool. For example, a newborn suffered from respiratory failure and was admitted to hospital in 221. The hospitalization expenses were 425,769.37 yuan, and the residents' medical insurance reimbursement was 326,521.67 yuan. A certain B, an old man, was hospitalized with coronary atherosclerotic heart disease in 222. The hospitalization expenses were 284,169.89 yuan, and the residents' medical insurance reimbursement was 217,428.11 yuan. In a word, it is "I am for everyone and everyone is for me". 3. My family's annual income is very low. What should I do if it is difficult to pay the residents' medical insurance in full? A: The Party and the state attach great importance to people's livelihood issues. As an important people's livelihood security department, the medical insurance department has always adhered to the people-centered development idea and strived to reduce the personal contributions and medical expenses of the people who are in difficulty in participating in the insurance. Therefore, if you are identified as a person with special difficulties by the departments of civil affairs, rural revitalization, and the Disabled Persons' Federation due to low annual family income, in 223, you will enjoy the following subsidy policies accordingly: 1. The funds needed for the individual contributions of extremely poor people, orphans, minors who are actually left unattended, retired old workers in the early 196s, and patients with mental disorders who cause trouble will be fully funded by the medical assistance fund. 2 family planning "two households" and family planning special family members to pay the required funds by the county finance in full. 3. The minimum target, the unstable population out of poverty, the marginal poverty-prone population, and the population with sudden serious difficulties shall be funded by the medical assistance fund according to the standard of 175 yuan/person. 4. The elderly who have reached the age of 6 or above, minors under the age of 18 and severely disabled people in low-income marginal families are funded by the medical assistance fund according to the standard of 15 yuan/person. 5. The stable poverty-stricken population that is not included in the above target range shall be funded according to the 12 yuan per capita standard. In addition to subsidizing insurance, our province also gives corresponding medical insurance preferential policies to some people with special difficulties in terms of deductible, reimbursement ratio and payment limit. For example, the deductible line for serious illness insurance such as destitute people, orphans, minors who are actually left unattended, low-income recipients, unstable population out of poverty, marginal poverty-prone population, and population with sudden serious difficulties will be reduced by 5%, the reimbursement ratio will be increased by 5 percentage points, and the top line will be cancelled. For example, in a county, the low-income object was admitted to hospital with lung infection and other diseases, and the hospitalization expenses were 219,562.88 yuan, and the residents' medical insurance reimbursement was 193,447.51 yuan. Therefore, if your family is in financial difficulties and has a weak ability to resist disease risks, you should participate in residents' medical insurance in time, so that you can not only enjoy the government's insurance subsidy policy, but also effectively reduce your financial burden once a family member falls ill. Fourth, why is there a threshold fee for medical insurance payment every time I go to see a doctor? Answer: The threshold fee is precisely the medical insurance deductible line. It is not the additional fees charged by medical insurance or hospitals to insured patients, but the bottom line of reimbursement when medical insurance pays the medical expenses of insured persons. This part of the expenses below the "deductible line" shall be borne by the patient himself. The deductible line is set according to the level of medical institutions. The higher the hospital level, the higher the deductible line. There are two main purposes for this setting. One is to enhance the awareness of cost saving. With the part that individuals have to bear, it can avoid seeing a doctor and prescribing drugs at will, wasting limited medical resources and medical insurance funds, and also prevent outpatient clinics from being transferred to hospitalization and minor illnesses from being cured. The second is to ensure that more insured patients have a high cost burden. Under normal circumstances, within the payment limit (capping line) of medical insurance, the more expenses incurred in medical treatment, the higher the cost of medical insurance reimbursement. The expenses below the deductible line are basically the part that individuals can fully bear, so medical insurance will not pay, but this part of the expenses can be used to protect more insured patients with high medical expenses. This is the origin of the threshold fee for medical insurance payment. Do you understand? 5. Why did I pay for the insurance, and some expenses were not reimbursed? A: No matter whether it is employee medical insurance or resident medical insurance, the funds raised are limited, and it is impossible to cover all medical needs. Limited funds can only be used to "protect key points" on the cutting edge, rather than "equalitarianism". At present, the scope of medical insurance reimbursement is mainly based on the "three catalogues" defined by the state, namely "the catalogue of medical insurance drugs, the catalogue of medical treatment items and the catalogue of medical service facilities". Medical insurance will not pay the expenses beyond the three catalogues, such as health care consumption and items that should be paid from the industrial injury insurance fund. That's why you have to bear some of the expenses yourself. In recent years, many common and frequently-occurring diseases have been included in the medical insurance payment. Therefore, the content of medical insurance fund payment is not static, but with the continuous increase of financing standards, it constantly adapts to the actual medical needs of the people. In recent years, the state has accelerated the frequency of adjusting the medical insurance drug list and included more life-saving and emergency anticancer drugs in medical insurance payment. In 221, the soul bargaining of the National Medical Insurance Bureau may still be fresh in your memory! The phrase "people's health is paramount, and every small group should not be given up" has moved many people. When the drug Nocicnatrium sodium injection for the treatment of spinal muscular atrophy, a rare disease, was initially 7, yuan per injection, and was finally cut to 33, yuan at the price of 53,68 yuan, the price was greatly reduced, and it was also included in the medical insurance payment, and how many patients' families cheered for it, which was a real benefit for the insured patients. 6. Is it a bit of a loss to pay for medical insurance for many years and never use it? Answer: Medical insurance is "insurance" rather than "saving money". Medical insurance is to help patients in need to resist unpredictable diseases and economic risks by putting together the money paid by everyone and the money subsidized by the state. If someone needs the medical insurance fund today, he or she can use it first, and you can use it again tomorrow if you need it. As the saying goes, people who eat whole grains are guaranteed not to get sick. No one can control the uncertainty and contingency of disease risk. Of course, as a medical insurance department, we hope that because of your good health, you have paid the insurance premium but never used it, because no one wants to come to you. Because of the fear of "losing money", the case of sudden illness leading to the hollowing out of family property overnight has also really happened around us. In fact, this is just like auto insurance. You certainly didn't buy insurance because you wanted to damage your car! In fact, it is to buy a peace of mind, buy a peace of mind, and help each other when the real risk comes. You said, right?