The individual payment standard of urban and rural residents in our city has been raised to 150 yuan, and the financial subsidies at all levels have been raised to 4 10 yuan simultaneously, and the per capita financing level of residents' medical insurance has reached 560 yuan. From next year, the annual payment will be realized at any time, and the newborn can be insured when it is 6 months old; Other insured persons (family as a unit) after March of that year 1 can enjoy the medical insurance benefits of that year after paying 560 yuan/person (individual pay 150 yuan +4 10 yuan subsidies) in full and waiting for 30 days.

The resident population who is not a resident of our city can apply for medical insurance with residence permit or residence certificate.

Special people don't need to pay personal expenses.

College students who have participated in residents' medical insurance can be transferred to employee medical insurance after taking part in work. Since 20 15, college students have participated in residents' medical insurance in our city for three consecutive years, and continue to work in our city after graduation, which can be converted into employee medical insurance payment 1 year.

Reform the reimbursement treatment of general outpatient service. The maximum payment limit of general outpatient service at county and village levels is adjusted to per person 120 yuan, which is regarded as a nominal personal account, and it is clearly stipulated that it cannot be cleared and can be carried forward to the next year. Combined with the payment limit of the next year, the family members can * * *, which cancels the practice of clearing the original general outpatient service of the new rural cooperative medical system 170 yuan at the end of the year.

The adjustment of medical insurance policy mainly involves: increasing the proportion of hospitalization reimbursement in first-class and second-class designated hospitals that have cancelled drug addition from 80% and 65% to 85% and 70% respectively, while the proportion of hospitalization reimbursement in first-class and second-class designated hospitals and third-class hospitals that have not completely cancelled drug addition remains unchanged;

Will meet the conditions of hospital Chinese medicine preparation into the scope of medical insurance reimbursement, the proportion of outpatient reimbursement of Chinese medicine decoction pieces (Chinese medicine decoction pieces) in first-class designated hospitals will be increased by 5%, and the proportion of hospitalization reimbursement of Chinese medicine decoction pieces (Chinese medicine decoction pieces) in designated hospitals at all levels will be increased by 5% accordingly, but the highest reimbursement ratio will not exceed 90%; Reduce the proportion of individuals paying for Class B drugs in the residents' medical insurance drug list10%;

The maximum unit price of high-value medical consumables for residents' medical insurance will be raised to 30,000 yuan, and the maximum reimbursement limit for accidental injury medical expenses within one year will be 50,000 yuan per person.

Insured patients identified as special diseases of hypertension, chronic diabetes and severe mental illness are treated in township hospitals and community health service centers where national essential drugs are implemented, and there is no deductible. The specific drug reimbursement ratio is 100%. The original reimbursement policy shall be implemented if the insured patients need to use drugs other than specific drugs or be treated in the outpatient department of designated hospitals at or above the second level.

Specific drugs include hypertension drugs: compound reserpine tablets, amlodipine, nimodipine, nitrendipine, nifedipine, propranolol, metoprolol, hydrochlorothiazide, captopril, valsartan10;

Diabetes drugs: metformin, glibenclamide, glipizide, glimepiride, Xiaoke pills;

Drugs for severe psychosis: perphenazine, haloperidol, risperidone, chlorpromazine, clozapine, sulpiride, lithium carbonate, penfluridol.

There is no need to provide "Family Planning Service Manual", "Marriage Certificate" and other materials for reimbursement of hospital delivery quota for hospitalized pregnant women.

The scope of compliance medical expenses for serious illness has been expanded: first, the drug expenses stipulated in the drug list (including class B drugs paid by individuals). Second, the rest of the expenses (including the part paid by individuals) except the items that are not paid (all at their own expense) within the catalogue of medical treatment items and medical service facilities. The third is the cost of five kinds of molecular targeted anti-tumor drugs, namely, Imatinib Mesylate Tablets (Gleevec), Ektinib Hydrochloride Tablets (Ke Mei Sodium), Tratuzumab (Herceptin), Rituximab (Rituximab) and Pemetrexed Disodium (Libitai).

Individuals purchase five kinds of targeted drugs such as imatinib mesylate tablets (Gleevec) at designated institutions (Municipal Public Security Hospital/Municipal Chronic Disease Management Center and lanshan district Hui You Pharmacy) with the certificate of serious illness in the county and the prescription issued by the responsible doctor, and return to the hometown people's society for manual reimbursement with the invoice; Individuals pay 50% first, and 70% for those above 500 yuan according to the special disease outpatient policy, and then they will be included in the serious illness insurance.

It is reported that in 20 15, the city should pay 293 million yuan to the provincial serious illness co-ordination fund. By the end of this year 10, the accumulated compliance expenses were 2.02 billion yuan, 92 120 patients were compensated for serious illness, and 298 million yuan was reimbursed for serious illness insurance, with a per capita reimbursement of 3,235 yuan. The actual reimbursement rate for serious illness was increased by 14.7% on the basis of basic medical insurance, and the medical burden of seriously ill patients was further reduced.

Interpretation of medical insurance policy

The reporter was informed at the briefing on the operation and policy adjustment of residents' basic medical insurance system held by the Municipal Human Resources and Social Security Bureau this morning that the medical insurance benefits will be further improved next year, and qualified hospital Chinese medicine preparations will be included in the scope of residents' medical insurance reimbursement. The out-of-pocket proportion of Class B drugs in the residents' medical insurance drug list will be reduced by 10%, and patients with hypertension, chronic diabetes and severe mental illness have been identified. In the outpatient treatment of township hospitals and community health service centers where national essential drugs are implemented, 23 kinds of specific drugs used 100% are reimbursed, and the people get more benefits.

The individual payment standard of urban and rural residents in our city has been raised to 150 yuan, and the financial subsidies at all levels have been raised to 4 10 yuan simultaneously, and the per capita financing level of residents' medical insurance has reached 560 yuan. From next year, the annual payment will be realized at any time, and the newborn can be insured when it is 6 months old; Other insured persons (family as a unit) after March of that year 1 can enjoy the medical insurance benefits of that year after paying 560 yuan/person (individual pay 150 yuan +4 10 yuan subsidies) in full and waiting for 30 days.

The resident population who is not a resident of our city can apply for medical insurance with residence permit or residence certificate.

Four special groups of people do not need to pay personal expenses.

College students who have participated in residents' medical insurance can be transferred to employee medical insurance after taking part in work. Since 20 15, college students have participated in residents' medical insurance in our city for three consecutive years, and continue to work in our city after graduation, which can be converted into employee medical insurance payment 1 year.

Reform the reimbursement treatment of general outpatient service. The maximum payment limit of general outpatient service at county and village levels is adjusted to per person 120 yuan, which is regarded as a nominal personal account, and it is clearly stipulated that it cannot be cleared and can be carried forward to the next year. Combined with the payment limit of the next year, the family members can * * *, which cancels the practice of clearing the original general outpatient service of the new rural cooperative medical system 170 yuan at the end of the year.

The adjustment of medical insurance policy mainly involves: increasing the proportion of hospitalization reimbursement in first-class and second-class designated hospitals that have cancelled drug addition from 80% and 65% to 85% and 70% respectively, while the proportion of hospitalization reimbursement in first-class and second-class designated hospitals and third-class hospitals that have not completely cancelled drug addition remains unchanged;

Will meet the conditions of hospital Chinese medicine preparation into the scope of medical insurance reimbursement, the proportion of outpatient reimbursement of Chinese medicine decoction pieces (Chinese medicine decoction pieces) in first-class designated hospitals will be increased by 5%, and the proportion of hospitalization reimbursement of Chinese medicine decoction pieces (Chinese medicine decoction pieces) in designated hospitals at all levels will be increased by 5% accordingly, but the highest reimbursement ratio will not exceed 90%; Reduce the proportion of individuals paying for Class B drugs in the residents' medical insurance drug list10%;

The maximum unit price of high-value medical consumables for residents' medical insurance will be raised to 30,000 yuan, and the maximum reimbursement limit for accidental injury medical expenses within one year will be 50,000 yuan per person.

Insured patients identified as special diseases of hypertension, chronic diabetes and severe mental illness are treated in township hospitals and community health service centers where national essential drugs are implemented, and there is no deductible. The specific drug reimbursement ratio is 100%. The original reimbursement policy shall be implemented if the insured patients need to use drugs other than specific drugs or be treated in the outpatient department of designated hospitals at or above the second level.

Specific drugs include hypertension drugs: compound reserpine tablets, amlodipine, nimodipine, nitrendipine, nifedipine, propranolol, metoprolol, hydrochlorothiazide, captopril, valsartan10;

Diabetes drugs: metformin, glibenclamide, glipizide, glimepiride, Xiaoke pills;

Drugs for severe psychosis: perphenazine, haloperidol, risperidone, chlorpromazine, clozapine, sulpiride, lithium carbonate, penfluridol.

There is no need to provide "Family Planning Service Manual", "Marriage Certificate" and other materials for reimbursement of hospital delivery quota for hospitalized pregnant women.

The scope of compliance medical expenses for serious illness has been expanded: first, the drug expenses stipulated in the drug list (including class B drugs paid by individuals). Second, the rest of the expenses (including the part paid by individuals) except the items that will not be paid (all at their own expense) within the catalogue of medical treatment items and medical service facilities. The third is the cost of five kinds of molecular targeted anti-tumor drugs, namely, Imatinib Mesylate Tablets (Gleevec), Ektinib Hydrochloride Tablets (Ke Mei Sodium), Tratuzumab (Herceptin), Rituximab (Rituximab) and Pemetrexed Disodium (Libitai).

Individuals purchase five kinds of targeted drugs such as imatinib mesylate tablets (Gleevec) at designated institutions (Municipal Public Security Hospital/Municipal Chronic Disease Management Center and lanshan district Hui You Pharmacy) with the certificate of serious illness in the county and the prescription issued by the responsible doctor, and return to the hometown people's society for manual reimbursement with the invoice; Individuals pay 50% first, and 70% for those above 500 yuan according to the special disease outpatient policy, and then they will be included in the serious illness insurance.

It is reported that in 20 15, the city should pay 293 million yuan to the provincial serious illness co-ordination fund. By the end of this year 10, the accumulated compliance expenses were 2.02 billion yuan, 92 120 patients were compensated for serious illness, and 298 million yuan was reimbursed for serious illness insurance, with a per capita reimbursement of 3,235 yuan. The actual reimbursement rate for serious illness was increased by 14.7% on the basis of basic medical insurance, and the medical burden of seriously ill patients was further reduced.