In recent years, Hefei residents' medical insurance has successively introduced new policies to continuously improve their treatment. The total number of people enjoying benefits reached 272,000, including general outpatient112,800, general outpatient110000, special disease outpatient 45 1000, and transferred to other places. "The actual payment rate of residents' medical insurance hospitalization fund in our city (including the expenses outside the medical insurance catalogue) increased from 2 1. 1% in the previous year to 36.6%; The proportion of medical expenses in the medical insurance catalogue has increased from 56.2% in the previous year to 76.5%, and the contradiction between doctors, insurance and patients has been greatly reduced, thus building a harmonious medical insurance. Fang, deputy director of the Municipal Bureau of Human Resources and Social Security, said: "We will continue to introduce new policies in the near future so that ordinary people can get more benefits." . "
Enjoy the benefits of insurance payment every year.
Every September, primary and middle school students in Hefei participate in the next year's residents' medical insurance at school; From July to September every year, residents of other non-school students go to the social neighborhood Committee where the household registration is located to participate in the insurance. /kloc-students under 0/8, children and non-employed residents each pay 30 yuan; A class of subsistence allowances and severely disabled people each pay 30 yuan; Other residents each pay 120 yuan. Newborns are insured for the first time, but they can go to the social security collection center at any time after completing the household registration, and each person will pay it to 30 yuan, and then they will be insured at a specified time every year. Financial subsidies at all levels: insured residents per year 140 yuan, of which the first-class minimum living allowance and severely disabled people per year 230 yuan.
Residents enjoy medical insurance benefits from June of that year 10 to September 30th of the following year.
Hospitalization reimbursement can reach up to 88%
Since the policy-based medical insurance for residents was launched in 2007, the proportion of hospitalization reimbursement has been increasing, from 40%, 50% and 60% in tertiary, secondary and first-class hospitals to 50%, 60% and 70%. The first-class subsistence allowances and severely disabled people will increase by 10 percentage point; Continuous participation in insurance will increase by 2 percentage points every year, and the cumulative participation will not exceed 10 percentage point. At present, the highest payment ratio of the fund can reach 88%. At the same time, the annual maximum payment limit of inpatient and outpatient special disease funds has also increased from 50,000 to 6.5438+0.2 million yuan.
Hospitalization in this city (see table 1):
For example, Uncle Wang, a low-income worker, has been insured for 4 years in a row and spent 3,092 yuan in a first-class hospital, of which 3 10 yuan (referring to class B drugs, diagnosis and treatment items and service facilities paid by individuals and expenses basically beyond the scope of medical insurance). Comparison of Uncle Wang's reimbursement before and after policy adjustment.
Before the adjustment, the deductible in 200 yuan was 60%, and the medical insurance expenses (hospitalization expenses minus personal out-of-pocket expenses) were 3092-3 10 = 2782 yuan. The medical insurance reimbursement is (2782-200) × 60% = 1549.2 yuan, and the reimbursement ratio is 50. 1%.
After adjustment, deductible is exempted, the proportion of hospitalization pooling fund payment is increased to 70%, the first-class minimum living standard is increased by 10 percentage point, and it is increased by 8 percentage points for four consecutive years, and the proportion of hospitalization pooling fund payment is 88%. His hospitalization reimbursement is 2782×88%=2448. 16 yuan, which is 898.96 yuan more than before the adjustment, and the reimbursement ratio is 79. 18%, which is 29.08 percentage points higher than before the adjustment.
Qifubiaozhun for off-site transfer and emergency rescue hospitalization is 600 yuan, and the proportion of fund payment is 40%; A class of low-income severely disabled insured fund payment ratio is 50%. Insured residents due to illness in the city's tertiary hospitals (or specialized hospitals) difficult to diagnose or diagnose clearly but no treatment, can apply for transfer to different places for hospitalization. Insured residents who need to be hospitalized in local medical institutions due to sudden diseases in different places should contact the municipal medical insurance center for registration within 3 working days after admission. In the meantime, the medical expenses will be paid by the individual first, and will be settled at the municipal medical insurance center within one month after discharge.
The number of special outpatient diseases has been expanded to 25.
For example, Sun Moumou, a 5-year-old insured child, suffered from cerebral palsy after birth. To this end, his family sought medical treatment everywhere, and tens of thousands of medical expenses every year were undoubtedly worse for this originally poor family. After the children's cerebral palsy in Hefei was included in the special diseases of residents' medical insurance outpatient service, the parents of the children could apply for the special disease treatment card of children's cerebral palsy outpatient service at any time, thus reducing the hospitalization burden. From March 20 10 to April 20 1 172 yuan outpatient medical expenses, 2 1294.75 yuan was reimbursed by medical insurance, and the reimbursement rate reached 70%. At present, 140 children in the city have enjoyed this medical insurance treatment, and the fund * * * paid 887 10000 yuan, and the reimbursement rate reached 70.22%.
The number of special diseases in policy outpatient service has been expanded from 1 at the beginning to 25, and the proportion of fund payment has been increased from 50% to 60%, of which the proportion of fund payment for children with cerebral palsy has reached 70%. These 25 kinds of outpatient special diseases have different fund payment limits, of which the maximum annual payment limit after renal dialysis and kidney transplantation is 30 thousand yuan; The maximum annual payment limit for children with cerebral palsy is 20,000 yuan. In addition,/kloc-students, children and insured residents under the age of 0/8, suffering from aplastic anemia, hemophilia, malignant tumor and cerebral palsy in children, have no minimum fund payment standard.
Reimbursement for medical treatment in community general outpatient department
For example, "you can still be reimbursed if you are not hospitalized, and it is convenient and affordable to go to the clinic at home." Aunt Li is a 66-year-old landless farmer who lives in Hu Lin Community Neighborhood Committee of Economic Development Zone. She has not been hospitalized since she joined the insurance in 2007. She usually sees a doctor in a nearby community health service center for some minor problems. "I couldn't reimburse the clinic before, and it was still a few hundred a year. Since June 5438+ 10 last year, my outpatient service has spent 560 yuan, and medical insurance has spent 200 yuan. " Now Aunt Li has become a volunteer propagandist, introducing the benefits of residents' medical insurance to neighbors with her own personal feelings. According to statistics, since the start of general outpatient service, * * * has 1 12 125 visits to outpatient service, and the fund paid 1355200 yuan.
Policy Since May of 20 10 and 1 year, Hefei will withdraw the general outpatient co-ordination fund from the residents' medical insurance co-ordination fund according to the standard of 40 yuan per person per year (insured residents will not pay separately). Every time the insured residents go to the general outpatient service of designated medical institutions for medical treatment, the fund will pay 40% of the medical insurance expenses, and the 30 yuan will be reimbursed at most once. The maximum annual payment limit of the fund is 1.20 yuan, among which, the insured residents over 60 years old and women over 55 years old will receive 80 yuan. Community health service centers in 49 towns in Hefei are designated medical institutions for general outpatient service.
Newborns can be insured at any time and enjoy treatment.
For example, medical insurance for newborns: the newborn Hongmou was born in the Municipal Maternal and Child Health Hospital on 20 10, 12 and 17, and was treated successively in the Municipal Maternal and Child Health Hospital, the Provincial Children's Hospital and the Second Affiliated Hospital of Anyi University for suffering from neonatal hypoxic-ischemic encephalopathy. Participate in residents' medical insurance within three months after birth, hospitalization expenses 17438+0 1.7 yuan, medical insurance reimbursement 1 yuan.
Maternity allowance: since June last year, 65438+ 10, * *185 people have enjoyed the maternity allowance policy, and the fund paid 1 158600 yuan, with a per capita allowance of 977 yuan.
Policy newborns can participate in insurance payment at any time after household registration, and enjoy medical insurance benefits from the date of payment. Newborns suffer from congenital heart disease, phenylketonuria, hepatolenticular degeneration, glycogen storage disease, neonatal hypothyroidism, neonatal adrenal hyperplasia, neonatal hemolysis, premature and neonatal hypoxic-ischemic encephalopathy, neonatal intracranial hemorrhage, neonatal respiratory distress syndrome, neonatal sepsis, neonatal infectious pneumonia, congenital hypertrophic pyloric stenosis, congenital megacolon, congenital biliary atresia, etc. Participate in residents' medical insurance within three months from the date of birth and enjoy medical insurance benefits from the date of birth.
From 20 10, 10 and 1 onwards, the insured residents who meet the family planning policy will be given subsidies according to the standards of cesarean section 1200 yuan and natural delivery in 600 yuan.
Insured disabled people have subsidies for assembling assistive devices. Insured and certified lower limb disabled persons and children with hearing impairment under 7 years old shall be equipped with lower limb prostheses and hearing AIDS in the designated institutions for assembling assistive devices for the disabled in our city. Ordinary thigh prosthesis is subsidized by 2000 yuan every five years, calf prosthesis 1 000 yuan, and hearing aid for children under 7 years old is subsidized by 2400 yuan.
College students suffering from serious illness have adjustment funds.
For example, a sophomore in Anhui College of Traditional Chinese Medicine suffered from acute myeloid leukemia and was hospitalized for three times, which cost a huge amount of medical expenses of 47160,000 yuan, medical insurance fund reimbursement of10/85,000 yuan, and college students' provincial adjustment fund reimbursement of166,000 yuan, accounting for 60.3%.
Insurance payment policy, college students take their colleges and universities as the insured units, register and pay insurance fees in September every year, each person pays 35 yuan, and financial subsidies at all levels are given per person per year 120 yuan. Enjoy treatment (see table 2).
Medical insurance fund to pay more than the limit, suffering from serious and difficult diseases, family economic difficulties, you can apply to the provincial medical insurance agencies for college students to be hospitalized in different places.
College students' hospitalization in different places includes hospitalization in different places, emergency treatment in different places, internship, winter and summer vacations, suspension from school, legal holidays and other off-campus hospitalization. To transfer to a different place, the hospital should first fill in the application form, and then go to the medical insurance center for transfer procedures. The hospitalization expenses in different places shall be paid in advance by individuals or schools, and shall be reimbursed to the medical insurance center within two months after discharge. There are many college students who seek medical treatment in different places, and 1 122 people have enjoyed reimbursement for medical treatment in different places.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.