1. What is long-term care insurance?

Long-term care insurance (hereinafter referred to as "long-term care insurance") system refers to a social insurance system that raises funds in the form of social mutual assistance and provides basic life care and medical services or economic security for long-term disabled people who have reached a certain level of nursing needs after evaluation.

Second, what is the financing standard for long-term care insurance?

1, employees' medical insurance personnel, according to the proportion of the employee medical insurance payment base paid by the employer 1%, adjust funds from the employee medical insurance pooling fund quarterly as long-term insurance financing.

2, residents' medical insurance personnel, according to their number, according to the per capita financing level is slightly lower than the first category of personnel, from the residents' medical insurance fund to adjust funds quarterly as long-term insurance financing. Specific financing standards, agreed by the Municipal Human Resources and Social Security Bureau (Municipal Medical Insurance Office), the Municipal Finance Bureau and other relevant departments, and implemented after the approval of the municipal government.

3. Who can apply for long-term care insurance benefits?

In the pilot stage, people who meet the following conditions can enjoy long-term insurance benefits:

1, employees, medical insurance personnel and residents' medical insurance personnel who have reached the age of 60 or above and have gone through the formalities of applying for basic pension according to regulations;

2, the elderly care needs assessment, the degree of disability reached the assessment level of two to six long-term care insurance insured.

4. What is the unified needs assessment for the aged?

The unified assessment of nursing needs of the elderly refers to the assessment of disability, disease status and nursing status of the elderly who have nursing needs and meet the prescribed conditions according to the unified assessment standards of the whole city, and determine the nursing level. Nursing grade is the premise and basis for applicants to enjoy long-term care insurance benefits and pension service subsidies.

5. How long is the validity period of the unified needs assessment for the aged?

The validity of the appraisal conclusion shall not exceed 2 years. During the validity period of the evaluation conclusion, if the applicant's self-care ability changes, he may reapply for evaluation. Within 60 days before the expiration of the validity period of the appraisal conclusion, the applicant shall reapply for appraisal.

6. What is the cost of unified needs assessment for the aged? How to pay?

The assessment fee is implemented according to the charging standard of the Municipal Price Bureau on the unified needs assessment project for the elderly care in this city, and the charging standard is 200 yuan every time.

The expenses incurred in the initial evaluation, final evaluation and evaluation of the applicant's application for long-term insurance benefits shall be paid by the long-term insurance fund, and the rest shall be borne by the individual.

7. What is the process of applying for long-term care insurance benefits?

Insured persons can independently apply to the nearest community affairs acceptance service center and choose the designated nursing service institutions that suit them. Fixed-point assessment agencies organize assessors to complete the unified needs assessment of elderly care. After receiving the notice, the community affairs acceptance service center will inform the applicant of the evaluation results. After confirming the service relationship with the designated nursing service institutions, the insured with long-term care insurance with the evaluation grade of two to six can enjoy the corresponding long-term care insurance services.

8. What are the service forms of long-term care insurance?

Long-term care insurance has three different nursing service modes: the first is community home care, that is, nursing stations and community pension service institutions provide home care or community day-time centralized care and related medical care services for the insured at home; The second category is the care of old-age care institutions, which means that old-age care institutions provide basic living care and related medical care services for the insured who live and raise; The third category is hospitalization, which refers to providing inpatient medical care services for the insured who are hospitalized in designated medical institutions that undertake the function of elderly care.

9. What are the services of community home care and nursing home care of long-term care insurance?

There are 42 specific services in community home care for the aged, which are divided into basic life care and common clinical care, such as head and face cleaning and modification, bathing, assisting eating/drinking, incontinence care, self-care ability training, nasal feeding and ostomy care. These services have a great demand for disabled elderly people, and are suitable for homes and old-age care institutions, so they are relatively safe.

10. What is the compensation standard for community home care in long-term care insurance?

The weekly on-site service time of community home-based care for the aged is: if the evaluation level is Grade II or III, the service time shall not exceed 3 hours/week; If the assessment level is level 4, the service time shall not exceed 5 hours/week; If the assessment level is Grade 5 or Grade 6, the service time shall not exceed 7 hours/week.

During the evaluation period, 90% of the expenses of community home care service incurred by the insured shall be paid by the long-term insurance fund, and 10% shall be borne by the individual.

Xi。 Are there any preferential policies for severely disabled elderly people who have been receiving home care services for a long time?

In order to embody the principle of encouraging home-based care for the aged, the insured who has received home-based care for the aged for more than 1 month and less than 6 months and whose assessment level is level 5 or 6 shall be given an additional service time of 1 hour per month on the basis of the specified weekly service time of 7 hours, or a cash subsidy from 40 yuan; Those who have received home-based care for the aged for more than 6 months in a row will be given 2 hours of service per month on the basis of the stipulated 7 hours of service per week, or cash subsidies from 80 yuan.

12. what is the standard of nursing payment for long-term care insurance pension institutions?

Insured persons with assessment grades of two to six can enjoy the care of old-age care institutions. Guarantee the access conditions of basic old-age care institutions, in accordance with the relevant provisions. According to the regulations, the municipal medical insurance center and the designated nursing service institutions agree on the payment standard of long-term care insurance for nursing services in old-age care institutions through service agreements.

The payment level of the long-term insurance fund is 85% of the service fee that the insured meets the requirements of the old-age care institution during the evaluation period.

Thirteen, long-term care insurance hospitalization what services? What is the payment standard?

The service content of hospitalization is implemented with reference to the diagnosis and treatment items, medical service facilities and medication scope of employee medical insurance. The standard of hospitalization medical charges shall be implemented in accordance with the relevant provisions of the current medical service items and price compilation of medical institutions in this Municipality.

The expenses incurred by the insured during hospitalization shall be handled in accordance with the relevant provisions of this Municipality's employee medical insurance or resident medical insurance.