Notice of Beijing Municipal Medical Security Bureau on Further Improving the Medical Security Policy for Serious Illness in this Municipality
Medical insurance bureaus in all districts, Social Bureau of Beijing Economic and Technological Development Zone, and designated medical institutions:
In accordance with the spirit of the Opinions of the General Office of the State Council on Improving the Medical Insurance and Assistance System for Serious and Serious Diseases (Guo Ban Fa [2021] No.42), in order to promote the complementary connection of the triple systems of basic medical insurance, serious illness insurance and medical assistance, we will implement the principle of "insurance first and then assistance" and further improve the medical insurance mechanism for urban workers and the medical insurance system for urban and rural residents (hereinafter referred to as "serious illness insurance").
First, the object of serious illness medical insurance is the insured of basic medical insurance for urban workers and urban and rural residents in this city.
Two, serious illness medical insurance costs were paid by the basic medical insurance fund for urban workers and urban and rural residents.
Three. Starting from June 65438+1 October1in 2023, the threshold for critical illness medical insurance is 30404 yuan. When the Qifubiaozhun needs to be adjusted, it will be announced by Beijing Medical Insurance Bureau in due course.
Four, the city's basic medical insurance insured persons enjoy basic medical insurance benefits, medical expenses paid by individuals within the scope of the basic medical insurance policy, which exceed the Qifubiaozhun for serious illness medical insurance, are included in the medical insurance coverage for serious illness.
Personal out-of-pocket medical expenses within the scope of the basic medical insurance policy include:
(a) the basic medical insurance fund Qifubiaozhun below the medical expenses;
(two) medical expenses borne by individuals in proportion from the minimum threshold of the basic medical insurance fund to the maximum payment limit;
(3) The medical expenses that should be borne by the individual in advance for the drugs listed in the drug list of basic medical insurance, industrial injury insurance and maternity insurance in Beijing;
(four) medical expenses that should be paid in advance by individuals within the scope of the basic medical insurance diagnosis and treatment items and medical service facilities;
(five) medical expenses that can be included in the scope of reimbursement above the maximum payment limit of the basic medical insurance fund and medical expenses that meet the requirements of items (three) and (four).
Five, the implementation of medical insurance for serious illness "subsection calculation, cumulative payment". 60% of the medical expenses accumulated above the Qifubiaozhun (excluding) and within 50,000 yuan (including) shall be paid by the basic medical insurance fund; Personal medical expenses exceeding 50,000 yuan shall be paid by the basic medical insurance fund by 70%, with no ceiling.
Six, for poor dependents, the minimum living security object and the living difficulties subsidy object, urban and rural low-income family relief workers and other needy people, the threshold of medical insurance for serious illness is reduced by 50%, and the personal medical expenses accumulated above the threshold (excluding) are less than 50,000 yuan (including), and 65% are paid by the basic medical insurance fund; Personal medical expenses exceeding 50,000 yuan shall be paid by the basic medical insurance fund by 75%.
Seven, in 2023, 1, 1, the city's basic medical insurance participants in the designated medical institutions for serious illness medical security costs to implement a "one-stop" real-time settlement.
Eight, this notice shall be implemented as of June 2023 1 day. If the previous provisions are inconsistent with this notice, this notice shall prevail.