New medical insurance policy in 217 1: Basically realize nationwide medical insurance networking in 217

On the afternoon of the 13th, the Ministry of Human Resources and Social Security held a news briefing on the China Municipal Government's "Outstanding Achievement Award in Social Security" by the International Social Security Association. In response to the progress of direct settlement of hospitalization expenses in different places, Huang Huabo, deputy director of the Social Insurance Management Center of the Ministry of Human Resources and Social Security, said on the 13 th that the Ministry of Human Resources and Social Security and the Ministry of Finance have jointly issued documents recently, with the goal of basically realizing national networking by the end of 216 and starting the direct settlement of hospitalization medical expenses for retirees in different provinces; In 217, it began to gradually solve the direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces, and at the end of the year, it was extended to the direct settlement of hospitalization medical expenses for people who met the referral requirements.

In p>217, the new medical insurance policy 2: medical treatment in different places has made two major breakthroughs.

In response to a reporter's question, the relevant person in charge said that in order to do a good job in the direct settlement of hospitalization expenses for medical treatment in different places, the Ministry of Human Resources and Social Security set up a special working group, formulated a work plan, made clear the tasks, reversed the time, and focused on tackling key problems. At present, some major breakthroughs have been made, mainly in two aspects:

December 9. This is the No.12 of 216 issued by the Ministry of Human Resources and Social Security. The document defines the objectives and tasks, basic principles, major policies, settlement mode, handling procedures, responsibilities of ministerial and provincial platforms, and the construction of information systems.

last week, the national settlement system for medical treatment in different places passed the preliminary acceptance. This indicates that this work has officially turned from policy decision-making and system construction to policy implementation and trial operation of system docking between departments and provinces. At the same time, strengthen the dispatch of Beijing-Tianjin-Hebei, Shanghai, Guangdong and other places, and urge all localities to achieve cross-provincial medical insurance settlement this year, and dock with the ministerial system to make preparations.

new medical insurance policy for 217 3: realize the direct settlement of medical expenses of compliance personnel in different places by the end of 217

When will the direct settlement of medical expenses in different places be realized? The Ministry of Human Resources and Social Security also gave the answer:

basically realize national networking in p>216, which is a key word.

Initiate the direct settlement of hospitalization medical expenses for retirees placed in different places across provinces. One key word in this is "Initiate". In addition, there are retirees who are resettled in different places across provinces, not all retirees.

in 217, the direct settlement of medical expenses of retirees resettled in different provinces will be gradually solved, not by the end of 216, but by the end of 216, and the direct settlement of medical expenses of retirees resettled in different places will be solved in 217.

New medical insurance policy in 217 4: Residents' medical insurance payment policy in 217

First, the individual payment standard will be adjusted appropriately. With the improvement of medical consumption level, the state has increased the financial subsidy funds for residents' medical insurance year by year, and the individual payment standard in 217 will also be appropriately raised. The payment standards are 6 yuan for students and children, 1 yuan for elderly residents aged over 6, and 3 yuan for other unemployed urban residents, which are raised in 1 yuan, 3 yuan and 1 yuan respectively. Minimum living allowances, disabled persons and "three noes" individuals still do not have to pay.

Second, the medical expenses of newborns can be reimbursed retroactively. According to the new policy, the newborn will pay for residents' medical insurance within 9 days (including 9 days) from the date of birth, and the medical expenses for hospitalization due to illness from the date of birth can be paid by the medical insurance fund according to regulations.

Third, the outpatient appointment institution cannot be "bound without authorization". From January 1, 217, insured residents can enjoy the overall treatment of outpatient service according to the regulations only by holding the "Medical Certificate" to the selected outpatient appointment institution for the first time. There is no need to go through the appointment procedures in advance, and the outpatient appointment institution shall not "bind without authorization" against the will of the insured residents.

new medical insurance policy in 217 5: medical insurance reimbursement in 217

1. scope of medical insurance reimbursement for serious illness in 217

1. malignant tumor treatment: including chemotherapy (including endocrine-specific anti-tumor treatment), radiotherapy, isotope anti-tumor treatment, interventional anti-tumor treatment and traditional Chinese medicine anti-tumor treatment.

2. outpatient hemodialysis and peritoneal dialysis for severe uremia.

3. Anti-rejection therapy after renal transplantation.

4. Treatment of mental illness: schizophrenia, depression (moderate or severe), mania, obsessive-compulsive disorder, mental retardation with mental disorder, epilepsy with mental disorder, paranoid psychosis.

It should be noted that the following situations are not covered by the reimbursement of medical insurance for serious illness:

1. Those who go to a non-designated hospital without approval (except for emergency rescue);

2. Party B suffers from occupational disease, work-related injury or relapse of work-related injury; Injuries caused by traffic accidents;

3. Injuries are caused by my violation of the law;

4. Food poisoning caused by accident;

5. Treatment due to suicide (except psychotic episode);

6. Injuries caused by medical accidents;

7. according to the provisions of the state and this municipality, medical expenses should be paid by themselves.

second, the proportion of medical insurance for serious illness in 217

1. deductible: 2, yuan. More than 2, yuan can be reimbursed through serious illness medical insurance.

2. Above the deductible line, the reimbursement rate for serious illness medical insurance is:

1) 2,-5, yuan: 5% for serious illness medical insurance;

2) 5, yuan-1, yuan: medical insurance for serious illness is reimbursed at 6%;

3) more than 1, yuan: medical insurance for serious illness will be reimbursed by 7%.

3. Annual reimbursement ceiling line: 3, yuan.

Third, the reimbursement process of serious illness medical insurance in 217

1. Materials required for reimbursement of serious illness medical insurance

1) ID card of the insured;

2) the insured person's medical guarantee or medical insurance card;

3) Original and photocopy of medical expense settlement list.

2. Medical insurance reimbursement process for serious illness

1) Insured personnel need to bring the above materials to the medical insurance department of the local designated hospital to fill in relevant forms for preliminary examination; 2) Designated hospitals will report the information of qualified insured residents in the first instance to the medical insurance agencies in cities and towns for review;

3) The insured residents who pass the final examination shall be organized by the medical insurance agencies in cities and towns to issue medical insurance reimbursement for serious illness.

IV. Reimbursement period of medical insurance for serious illness in 217

The maximum period is two years from the date of first diagnosis or recurrence of malignant tumor, among which Chinese herbal medicine treatment for malignant tumor can be enjoyed for five years.

compared with previous years, what changes have been made in the new medical insurance policy for serious illness in 217? Its changes are mainly reflected in the following aspects: 1. Reduce the minimum payment standard: the minimum payment standard is reduced from 2, yuan to 18, yuan.

2. Increase the reimbursement rate: among them, the proportion of adult residents, children and college students who participate in the first payment will be increased from 6% to 65%; The proportion of adult residents who participate in the second payment is increased from 5% to 55%.

3. Increase of over-limit subsidy: 9% of employees' medical insurance participants will be reimbursed; Residents' medical insurance participants, adult residents, children and college students who pay the first grade will be reimbursed by 8%, and adult residents who pay the second grade will be reimbursed by 7%.

4. Increase of large subsidies: 75% of employees' medical insurance participants will be reimbursed; Adult residents, children and college students who pay the first grade will be reimbursed by 6%; Adult residents who pay the second grade will be reimbursed by 5%.

5. Children are vaccinated free of charge: children over 4 years old are vaccinated with the second dose of varicella vaccine free of charge.

Questions and answers related to the new medical insurance policy in p>217

1. How to use the money in the medical insurance card account

As we all know, employee medical insurance is generally divided into individual accounts and pooling accounts. How to use these two accounts respectively?

Personal account can pay the following expenses:

1. Drug purchase expenses of designated retail pharmacies, outpatient and emergency medical expenses;

2. Used to purchase commercial insurance, accident insurance, etc.;

3. Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund;

4. Exceed the threshold of the basic medical insurance pooling fund, and bear the personal expenses in proportion;

5. If the personal account is insufficient, I will pay for it.

The overall fund mainly pays the following expenses:

1. Medical expenses for hospitalization;

2. Outpatient medical expenses for taking anti-rejection drugs after radiotherapy for malignant tumor, renal dialysis and renal transplantation;

3. The medical expenses of patients admitted to hospital after emergency rescue shall be observed for seven days before hospitalization.

Second, the scope of medical insurance reimbursement

1. The reimbursement of medical insurance card is limited to the medical expenses above hospitalization caused by diseases and some accidents in designated hospitals.

the reimbursement formula is: (total expense-threshold expense-self-expense-cost overrun) *(75+ age *.2)%. Under normal circumstances, the actual reimbursement ratio ranges from 2% to 6%.

Self-funded drugs are not reimbursed, and 8% of Class B drugs are reimbursed. Bed fees are limited, and some inspection fees and medical treatment fees cannot be reimbursed according to regulations.

2. The reimbursement amount of medical insurance card is 4 times of the local social wage (accumulated value within one year).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

4. Reimbursement of serious illness insurance

After the insured suffers from a serious illness, the personal conceit that occurred in the designated medical institutions of the municipal medical insurance and met the requirements of the municipal medical insurance will be included in the payment scope of the residents' serious illness insurance, and 5% will be reimbursed by the serious illness insurance funds.

that is, reimbursement amount = self-funded part ×5%

III. Reimbursement ratio of medical insurance card

The Ministry of Human Resources and Social Security announced the Outline of the 13th Five-Year Plan for the Development of Human Resources and Social Security in July this year, and China will stabilize the proportion of hospitalization expenses paid by employees and urban and rural residents within the basic medical insurance policy at around 75%.

iv. new uses of the medical insurance card

1. It can be used as an identity card

On October 1, 215, the Criminal Law Amendment (IX) included the social insurance card in the range of documents that can be used to prove identity according to law. Whoever forges, alters or buys or sells social security cards shall be investigated for criminal responsibility according to law; Anyone who uses a forged, altered or stolen social security card of others shall be investigated for criminal responsibility according to law.

2. Some provinces and cities can be used for fitness

In the second half of this year, in some provinces and cities of Shandong, Chongqing and Jiangsu, employees themselves can use their personal account balance to carry out fitness activities in fitness venues. But it may not be used to buy food, clothing, fitness equipment or cash.

5. Attention should be paid to using the medical insurance card

1. It is forbidden to cash out

No unit or individual is allowed to violate the use scope and requirements of the medical insurance card, and it is strictly forbidden to withdraw cash.

2. Some provinces and cities can use medical insurance cards for the whole family

From the second half of this year, some provinces and cities, such as Zhejiang Province and Guangzhou City, the surplus funds of medical insurance personal accounts over the years can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, thus realizing mutual assistance among family members.

3. Medical insurance will not pay for the following situations

See a doctor in a non-designated medical structure or buy medicine in a non-designated retail pharmacy (except for emergency);

self-injury caused by fighting, drug abuse or other illegal acts;

treatment due to alcoholism, suicide, self-mutilation, etc.;

injuries caused by traffic accidents, medical accidents or other liability accidents;

and the situation that the individual should pay according to the national or local regulations.

VI. How to inquire about the balance of the medical insurance card

Insured personnel can call 12333 social security consultation telephone or inquire about the balance of personal medical insurance accounts through BOC savings offices, designated hospitals in urban areas and pharmacies.

Further reading: How to buy insurance, which is better, and teach you how to avoid these "pits" of insurance.