Medical assistance fairly covers residents and workers in difficulty who have a heavy burden of medical expenses, and classified assistance is implemented according to the categories of recipients.

Medical assistance targets include: poor people, low-income people, returning to poverty, marginal family members of low-income people, monitoring and helping people to prevent returning to poverty, and seriously ill patients who are not included in the above-mentioned assistance targets but have serious difficulties in their basic family life due to high medical expenses. If the object of assistance has the above multiple identities, it shall be implemented in accordance with the principle of not repeating the high position.

Other people with special difficulties specified by the government at or above the county level shall be given corresponding assistance according to the above categories of assistance objects.

Insurance subsidy standard

Residents and workers in difficulty participate in basic medical insurance according to law and enjoy the rights and interests guaranteed by the triple system according to regulations.

Classified subsidies shall be given to the individual contributions of the relief objects participating in the basic medical insurance for residents, and full subsidies shall be given to the poor; Give fixed subsidies to low-income objects, poor people returning to poverty, marginal family members of low-income objects and monitoring and assistance objects to prevent returning to poverty.

Medical Insurance and critical illness insurance

1. Give full play to the main guarantee function of basic medical insurance. Continue to consolidate the level of hospitalization treatment. Fill in the shortcomings of outpatient support, comprehensively establish a general outpatient co-ordination system for residents and employees before the end of 2022, and gradually increase the annual medical insurance payment limit according to the supporting capacity of the medical insurance fund. Standardize and unify the basic diseases and identification standards of chronic diseases and special diseases in outpatient clinics in the province, increase security, and strive to reduce the burden of medical expenses for chronic diseases and special diseases in outpatient clinics.

2. Enhance the burden reduction effect of major illness insurance. The annual deductible line of serious illness insurance for poor people, low-income people and poor people is 50% lower than that of residents' medical insurance and employees' medical insurance in the overall planning area, and the proportion of segmented reimbursement is increased by 5 percentage points, and the annual maximum payment limit of serious illness insurance is cancelled; Cancel the deductible line of special drugs for serious illness insurance of the above-mentioned personnel.

Coverage of medical assistance

According to the principle of "insurance first, then assistance", hospitalization expenses and outpatient expenses for chronic diseases and special diseases, expenses paid by individuals within the policy scope after being reimbursed by basic medical insurance and serious illness insurance, and expenses below the annual deductible and above the maximum payment limit of basic medical insurance and serious illness insurance are all included in the scope of assistance according to regulations, and the expenses for chronic diseases and special diseases in hospitals and outpatient departments are paid by the annual medical assistance and re-assistance limit to jointly prevent poverty risks.

Guarantee mode

1, implement medical assistance security by classification and stratification.

There is no annual deductible for medical assistance for poor people, low-income households and returning poor people. After reimbursement of basic medical insurance and serious illness insurance, the personal burden within the policy scope shall not be less than 70%, and the annual assistance limit shall not be less than 30,000 yuan.

After the triple system guarantee, the part with personal burden exceeding 5,000 yuan within the policy scope will be re-assisted at a rate of not less than 70%, and the annual re-assistance limit will not exceed 20,000 yuan.

For the monitoring and assistance objects of marginal family members with minimum living allowance and prevention of returning to poverty, after being reimbursed by basic medical insurance and serious illness insurance, the part with personal burden exceeding 3,000 yuan within the policy scope shall be given assistance at a rate of not less than 50%, and the annual assistance limit shall not be higher than the minimum living allowance standard.

After the triple system guarantee, the part with personal burden exceeding 1 10,000 yuan within the policy scope will be re-assisted at a rate of not less than 70%, and the annual re-assistance limit will not exceed 20,000 yuan. The specific standards are scientifically determined by the municipalities according to the support capacity of the medical assistance fund.

2. Establish a rescue mechanism for patients suffering from poverty and serious illness due to illness.

For patients who are poor and seriously ill due to illness, medical assistance shall be given through application. The specific identification method shall be determined by the Provincial Civil Affairs Department in conjunction with the Provincial Medical Insurance Bureau and other relevant departments. For those who meet the conditions of medical assistance for poverty and serious illness caused by illness, after being reimbursed by basic medical insurance and serious illness insurance, the personal burden within the policy scope exceeds more than 25% of the per capita disposable income of residents in the overall planning area last year, and assistance is given at a rate of not less than 60%, and the annual assistance limit is not higher than the minimum living standard.

The expenses borne by the individual can be traced back to 12 months before the month of application. Once it is recognized, it can enjoy an annual medical assistance treatment and assistance limit, and it is not allowed to apply again within one year. The specific standards shall be scientifically determined by the municipalities according to the situation of raising funds for medical assistance.

Pay after treatment.

Poor people, low-income households and those returning to poverty who have been referred by primary medical and health institutions for the first time are hospitalized in designated medical institutions throughout the city, and the hospitalization deposit is free.

Strengthen the main responsibility of cost control in designated medical institutions, and give priority to the use of drugs, medical consumables and medical services in the basic medical insurance catalogue for relief objects. If it is really necessary to use it beyond the catalogue, the patient informed consent system shall be implemented.

Source of information: Implementation opinions of the General Office of Shandong Provincial People's Government on improving the medical insurance assistance system for serious and serious diseases.