Outpatient co-ordination: In the basic medical insurance, the outpatient expenses of the insured are included in the reimbursement scope of the co-ordination fund.
Major illness co-ordination: Major illness co-ordination, also known as major illness medical fund co-ordination, refers to the establishment of a major illness medical fund system in a certain region or industry to co-ordinate the medical expenses incurred by employees of enterprises with various major illnesses, mainly to solve the problem of excessive burden of medical expenses incurred by employees of enterprises with major illnesses, and to implement unified collection, payment and management.
Serious illness medical insurance is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness. The purpose is to solve the problem of "poverty caused by illness and returning to poverty due to illness", so that most people will no longer fall into economic difficulties due to illness.
Medical assistance for serious illness refers to a new medical assistance system that relies on the basic medical insurance for urban residents (employees) and the settlement platform of the new rural cooperative medical system, with stable capital investment, * * * using the service platform, * * * enjoying information resources, synchronizing settlement and payment, standardized management and operation, obvious relief effect, fast service for people with difficulties and scientific coverage of urban and rural areas.
Extended data:
Guiding opinions on developing serious illness insurance for urban and rural residents
Contents of serious illness insurance for urban and rural residents
(1). The object of serious illness insurance is urban residents' medical insurance and the insured of the new rural cooperative medical system.
(2) scope of protection. The coverage of serious illness insurance should be connected with urban residents' medical insurance and the new rural cooperative medical system. The medical insurance for urban residents and the new rural cooperative medical system should provide basic medical security according to the policy. On this basis, the major illness insurance mainly guarantees the eligible medical expenses of urban residents compensated by medical insurance and the new rural cooperative medical system when the insured (co-insured) is seriously ill and the medical expenses are high.
High medical expenses can be judged by the fact that the accumulated annual compliance medical expenses of individuals exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents announced by local statistical departments, and the specific amount is determined by local governments. Compliance medical expenses refer to the actual and reasonable medical expenses (which can be stipulated not to be paid), which are determined by the local government.
All localities can also start to carry out serious illness insurance from diseases with heavy personal burden.
(3) Protection level. In order to avoid catastrophic family medical expenses for urban and rural residents and reasonably determine the compensation policy for serious illness insurance, the actual payment ratio is not less than 50%; The proportion of payment is determined according to the level of medical expenses. In principle, the higher the medical expenses, the higher the payment ratio. With the continuous improvement of financing, management and security, the proportion of reimbursement for serious illness will be gradually increased, and the burden of personal medical expenses will be reduced to the greatest extent.
Do a good job in connecting basic medical insurance, serious illness insurance and medical assistance for serious and serious diseases, establish a serious illness information notification system, timely grasp the medical insurance payment of seriously ill patients, strengthen policy convergence, and effectively avoid the problems of poverty caused by illness and returning to poverty due to illness. The designated medical institutions, medication and diagnosis and treatment scope of urban and rural medical assistance shall be implemented with reference to the relevant policies and regulations of basic medical insurance and serious illness insurance respectively.
References:
Central government network-guiding opinions on developing serious illness insurance for urban and rural residents