Medical mutual aid for serious illness refers to a social medical mutual aid system established by urban workers on the basis of participating in basic medical insurance to solve the problem that the insured patients exceed the maximum payment limit of the basic medical insurance pooling fund and ensure the medical needs of employees for serious illness.
First, the target of assistance
1. Key special care recipients: including rural demobilized soldiers, rural disabled soldiers above Grade III, separated Red Army personnel, veteran cadres in Soviet area and special care recipients living in county glorious hospital and county labor processing station. 2. Rural five-guarantee objects; 3. Rural residents; 4. Urban residents; 5. Other poor people with special difficulties as determined by the county people's government.
Two, one of the following circumstances shall not enjoy medical assistance.
1. Participating in prostitution and contracting sexually transmitted diseases; 2. Traffic accidents or industrial accidents; 3. Drunk injury, fighting, suicide, self-mutilation; 4 beyond the medical insurance drug list, diagnosis and treatment project directory and medical service facilities directory costs; 5. Other circumstances stipulated by laws and regulations.
Three. Medical assistance for diseases
1. Malignant tumor 2. Uremia (renal failure) 3. Severe hepatitis (cirrhosis or acute liver necrosis) 4. The fifth move. Acute myocardial infarction. Acute necrosis aunt 7. Other incurable diseases with annual medical expenses of more than 20,000 yuan determined by the people's governments at or above the county level and suffering from special infectious diseases prescribed by the state shall be given assistance in accordance with the relevant provisions of the state.
Fourth, the standard of assistance:
1. The rural five-guarantee object and the urban residents' minimum living allowance regular supplement object meet the medical (drug) expenses in the medical drug list and diagnosis and treatment project, and they are given assistance according to the proportion of 50%. However, the accumulated amount of assistance within one year shall not exceed 6000 yuan. 2. Non-supplementary objects in urban low-income households and rural low-income objects meet the list of medical drugs and the medical (drug) expenses in diagnosis and treatment projects exceed 1 1,000 yuan, and assistance is given according to the proportion of 20%, but the accumulated amount of assistance within one year does not exceed 4,000 yuan. 3. Those who have participated in the basic medical insurance for urban workers and have real difficulties in life, and the personal burden exceeds 20,000 yuan, the part exceeding 20,000 yuan will be rescued by 10%, but the accumulated amount of assistance within one year cannot exceed 2000 yuan. 4. In addition to the urban and rural subsistence allowances, five guarantees and personnel of state administrative institutions, other urban and rural residents suffer from prescribed diseases, and the medical (drug) expenses are more than 20,000 yuan. After being approved by the Urban and Rural Social Assistance Evaluation Committee of the County People's Government or the County Civil Affairs Bureau, the excess can be given assistance at 10%, but the amount of assistance within one year shall not exceed 2,000 yuan.
Verb (abbreviation of verb) application approval procedure
1. The householder submits a written application to the local village (neighborhood) committee, and submits the following written materials: (1) minimum living allowance certificate issued by the county civil affairs bureau, rural five-guarantee support certificate and special care certificate. (2) Official medical expense invoices and prescriptions, disease diagnosis and necessary medical records of public hospitals at or above the county level. (three) the medical expenses approved by the county medical insurance bureau or part of the medical expenses borne by individuals. (four) a copy of the identity card and household registration book of the head of the household and the patient. 2. comment. The village (neighborhood) committee conducted a preliminary investigation, held a neighborhood (village) people's congress for democratic appraisal and posted it for 3 days. If the masses have no objection, they shall fill it out and report it to the Township People's Government for review. 3. review. The Township People's Government shall conduct household survey and verification within 10 working days after receiving the application approval form and other related materials, and the qualified entrusted village (neighborhood) committee shall publish it on the bulletin board for 3 days. After the masses have no objection, they will sign the rescue opinions on the application approval form and report them to the county civil affairs bureau. 4. recognition. County Civil Affairs Bureau shall review the materials submitted by towns and villages, and the qualified entrusted village (neighborhood) committee shall be publicized on the bulletin board for 3 days. After no objection, sign the standard proportion and the maximum amount of assistance on the application approval form. Approved by the county medical insurance bureau. 5. rescue. The county medical insurance bureau conducts audit according to the total medical expenses, and according to the opinions signed by the county civil affairs bureau, handles it according to the drug list and the total medical expenses, and implements assistance. If the amount of assistance exceeds 1 ,000 yuan, it must be in arrears, and if it is less than 1 ,000 yuan, cash can be paid directly. Measures for the Implementation of Medical Assistance for Serious and Serious Diseases in Urban and Rural Areas Chapter I General Provisions Article 1 In order to ensure the health of vulnerable groups in urban and rural areas, improve the urban and rural social assistance system and promote the coordinated economic and social development in our region, these measures are formulated in accordance with the provisions of the Decision of the Central Committee of the State Council on Further Strengthening Rural Health Work and the Opinions of Hunan Provincial Civil Affairs Department, Hunan Provincial Health Department and Hunan Provincial Finance Department on Implementing Rural Medical Assistance, and in combination with the actual situation in our region. The medical assistance system in Nijo Castle Township is coordinated by the government and implemented by the civil affairs department. With the cooperation of health, finance and other departments, appropriate subsidies will be given to the medical expenses of rural five-guarantee households, rural low-guarantee households and urban low-guarantee households suffering from serious diseases according to certain standards to alleviate their poverty caused by illness. Article 3 The principles of establishing urban and rural medical assistance system: the principle that the level of assistance is compatible with the level of economic and social development and the ability of financial payment; Principle of territorial management; The principles of unified system, standardized management, openness and fairness; Start with a low standard, rescue by classification, and promote as a whole; The principle of saving everything. Chapter II Objects and Standards of Assistance Article 4 All Guzhuang members who hold five-guarantee certificates, low-guarantee in rural areas and low-guarantee in cities and towns within the jurisdiction of our district are the targets of medical assistance for serious and serious diseases in urban and rural areas. Medical assistance for serious illness in urban and rural areas, due to serious illness, individuals bear medical expenses of more than 3000 yuan, to give appropriate medical assistance. Article 5 After the start of the new rural cooperative medical system, rural five-guarantee households and urban and rural subsistence allowances must participate in the rural cooperative medical system before they can enjoy medical assistance for serious diseases in urban and rural areas. After the individual payment policy of rural cooperative medical care is reduced, it is still unable to pay the funds that the individual of rural cooperative medical care should pay, and the District Civil Affairs Bureau will implement all or part of the funding in the medical assistance fund so that they can enjoy the rural cooperative medical care treatment. Due to serious illness, after the cooperative medical subsidy, the individual's annual medical expenses are still more than 3,000 yuan, and then appropriate medical assistance is given. Article 6. The scope of disease relief is limited to the following five categories: (1) malignant tumor; (2) leukemia; (3) uremia; (4) Severe hepatitis (acute or subacute liver necrosis); (five) other serious surgical diseases and personal one-time hospitalization expenses reached more than 5000 yuan. Article 7 Medical assistance for serious illness in urban and rural areas shall be declared, approved and distributed by stages (one-time assistance may be provided when necessary), and the standard of assistance shall be based on the recipient families. If the family's annual accumulated medical expenses are between 3,000 yuan and 5,000 yuan, assistance shall be given according to the standard that the individual bears 20% of the medical expenses; If the family's annual accumulated medical expenses are more than 5,000 yuan, assistance will be provided according to the standard that the individual bears 30% of the medical expenses. The maximum amount of accumulated family assistance for the whole year is 3000 yuan. Chapter III Application Approval Procedure Article 8 Within 0/0 days after the treatment of serious illness, the applicant shall submit a written application to the village (neighborhood) committee of the domicile or residence, and truthfully provide the following materials: (1) Medical diagnosis of serious illness in that year, receipt of medical expenses and necessary medical records; (two) have participated in rural cooperative medical assistance and social mutual assistance; (three) poor people who have enjoyed other government medical assistance and social assistance; (4) Household registration book, ID card, copies of five guarantees and minimum living allowances and other supporting materials that should be provided. Ninth village (neighborhood) committee of the village (neighborhood) people's application, should be accepted in a timely manner, and the applicant to fill out the "medical assistance application form". The village (neighborhood) committee shall, within 5 days, conduct a preliminary examination of the relevant materials provided by the applicant, and submit all the materials to the township office for examination after issuing opinions on the medical assistance application form. Article 10 Township offices shall examine the medical assistance application forms and related materials submitted by the applicants item by item, and fill in the assistance opinions and amount in the application forms for those who meet the requirements and report them to the District Civil Affairs Bureau for examination and approval; Do not meet the conditions, should explain the reasons, and through the village (neighborhood) committee to inform the applicant in writing. According to the needs, the township office can investigate and verify the applicant's medical expenses and family economic status and other related materials by means of household surveys, neighborhood visits and letters. Eleventh District Civil Affairs Bureau shall complete the examination and approval of the medical assistance application form and related materials submitted by the township office within 20 working days. To meet the conditions of medical assistance, notify the township office to put forward rescue opinions; Do not meet the conditions of medical assistance, it shall explain the reasons and notify the applicant in writing by the township office. Chapter IV Fund Raising and Management Article 12 A medical assistance fund for serious diseases in urban and rural areas in Wulingyuan District shall be established. The fund is mainly raised through financial allocations at all levels and voluntary donations from the society. (a) the district finance invested special funds for urban and rural medical assistance according to certain standards, and included them in the fiscal budget at the same level at the beginning of that year. (two) the higher financial transfer payments into the special funds for urban and rural medical assistance. (3) Interest income from the medical assistance fund. (4) Social donations and other funds. Thirteenth urban and rural medical assistance funds into the financial accounts of social security funds, the implementation of special storage, special account management, earmarking. Article 14 The District Finance Bureau shall, according to the payment plan and rescue roster submitted by the District Civil Affairs Bureau, implement the capital budget and timely allocate the medical assistance funds to the civil affairs special account. Fifteenth medical assistance funds by the District Civil Affairs Bureau according to the actual needs, allocated to the township civil affairs office. Sixteenth medical assistance funds must be closed management, no unit or individual may intercept, occupy or misappropriate, and regularly publish the income and expenditure of medical assistance funds, and accept the supervision of relevant departments and society. Chapter V Medical Assistance Services Article 17 When an object enjoying medical assistance for serious diseases in urban and rural areas falls ill, medical services must be provided by a township health center or a county-level hospital where the household registration is located or lived. After the implementation of the rural cooperative medical system, medical services are provided by medical service institutions stipulated in the rural cooperative medical system or medical institutions at or above the county level. Article 18 Medical and health institutions shall, within the prescribed scope, provide medical services for medical assistance objects according to the drug list of new rural cooperative medical care or basic medical insurance, the list of diagnosis and treatment items and the list of medical service facilities. Improve and implement various diagnosis and treatment management systems, ensure service quality and control medical expenses. Article 19 In case of difficulty or serious illness, the relief object needs to be transferred to a non-designated medical institution, and the transfer formalities shall be handled with reference to the relevant provisions of the rural cooperative medical system or the basic medical insurance institution. Twentieth medical and health service institutions shall cooperate with the district civil affairs departments to do a good job in the examination and approval of medical assistance benefits, and provide necessary medical records, hospitalization expenses list and other relevant certificates. Chapter VI Management and Supervision of Assistance Article 21 The District People's Government shall set up a leading group for medical assistance for serious illness in urban and rural areas, headed by the deputy head in charge and attended by departments of civil affairs, health, finance, auditing and supervision, to be responsible for organizing, coordinating, managing and guiding the medical assistance for serious illness in urban and rural areas. Office of leading group for urban and rural medical assistance for serious illness, District Civil Affairs Bureau. Twenty-second District Civil Affairs Bureau is responsible for the daily management of medical assistance for serious and serious diseases in urban and rural areas in this area. The Township Civil Affairs Office undertakes the daily work such as declaration, examination, verification and reporting of medical assistance for serious illness in urban and rural areas of this unit, and coordinates and handles other matters of medical assistance for serious illness in this area. The village (neighborhood) committee shall set up a review team of 3 to 7 people, and the person in charge shall assist in the daily work of medical assistance for serious illness such as declaration, preliminary examination and reporting. Twenty-third district finance department shall, jointly with the district civil affairs department, formulate measures for the management of urban and rural serious illness medical assistance funds, timely allocate medical assistance funds in place according to the approved payment plan, and conduct follow-up supervision and inspection. Twenty-fourth district health departments should strengthen the supervision and management of medical and health institutions providing medical assistance services, and standardize the behavior of medical services; Improve service quality and efficiency, and ensure the implementation of medical assistance policies. Twenty-fifth district supervision and auditing departments shall track and supervise the management of medical assistance funds and the service quality of medical service institutions, and investigate and deal with violations of discipline and discipline in the management of medical assistance funds and medical services. Twenty-sixth medical assistance institutions and organizations at all levels in urban and rural areas shall regularly publish medical assistance policies for urban and rural serious diseases, the list of recipients and the amount of assistance, implement a medical assistance publicity system, and accept supervision by the masses. Edit this paragraph | Return to the medical assistance situation in the top provinces 4. Proportion of municipalities directly under the Central Government enjoying medical assistance Shanghai: urban 1. 1%, rural 2.6% Beijing: urban 0.3%, rural 2. 1% Tianjin: urban 0.08%, rural 1.4% Chongqing: urban 0.02%.