The Beijing Municipal Medical Insurance Bureau issued a notice on further improving the city’s serious illness medical insurance policy, which stated that starting from January 1, 2023, the minimum payment standard for serious illness medical insurance will be 30,404 yuan.
If the minimum payment standard needs to be adjusted, it will be announced by the Beijing Municipal Medical Security Bureau in a timely manner.
Notice of the Beijing Municipal Medical Security Bureau on Further Improving the City's Major Illness Medical Insurance Policy. All district medical insurance bureaus, the Social Affairs Bureau of Beijing Economic and Technological Development Zone, and all designated medical institutions: In accordance with the "General Office of the State Council's Notice on Improving the Medical Insurance and Assistance System for Major and Major Illnesses"
"Opinions" (Guobanfa [2021] No. 42), in order to promote the complementary connection of the three systems of basic medical insurance, critical illness insurance and medical assistance, implement the principle of "insurance first and then assistance", and further improve the city's urban employees' critical illness medical protection
Mechanism and critical illness insurance system for urban and rural residents (hereinafter referred to as "critical illness medical insurance"), the relevant matters are hereby notified as follows: 1. The objects of critical illness medical insurance are urban employees and urban and rural residents basic medical insurance participants in this city.
2. Expenditures for medical insurance for serious illnesses shall be paid by the basic medical insurance funds for urban employees and urban and rural residents respectively.
3. Starting from January 1, 2023, the minimum payment standard for serious illness medical insurance is 30,404 yuan.
If the minimum payment standard needs to be adjusted, it will be announced by the Beijing Municipal Medical Security Bureau in a timely manner.
4. After the participants of this city’s basic medical insurance enjoy the benefits of basic medical insurance, the portion of personal out-of-pocket medical expenses within the scope of the basic medical insurance policy that exceeds the threshold for critical illness medical insurance shall be included in the scope of critical illness medical insurance.
Individual out-of-pocket medical expenses within the scope of the basic medical insurance policy include: (1) Medical expenses below the minimum payment standard of the basic medical insurance fund; (2) Medical expenses above the basic medical insurance fund minimum payment standard and below the maximum payment limit should be borne by the individual in proportion.
(3) The medical expenses for the drugs in the "Beijing Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog" that should be borne by the individual in advance; (4) The medical expenses in the basic medical insurance diagnosis and treatment item catalog and the scope of medical service facilities
Category B medical expenses that should be borne by individuals in advance; (5) Medical expenses above the maximum payment limit of the basic medical insurance fund that can be included in the scope of reimbursement according to regulations and medical expenses that comply with (3) (4).
5. Medical insurance for serious illnesses shall be calculated by segments and paid cumulatively.
The basic medical insurance fund will pay 60% of the personal out-of-pocket medical expenses above the minimum standard (exclusive) and up to 50,000 yuan (inclusive); the basic medical insurance fund will pay 60% of the personal out-of-pocket medical expenses exceeding 50,000 yuan.
Pay 70%, no cap.
6. For needy groups such as extremely poor dependents, minimum living security recipients, people with life difficulties, and aid workers for low-income families in urban and rural areas, the minimum payment standard for serious illness medical insurance will be reduced by 50%, and the amount above the minimum standard (exclusive) will be accumulated to 50,000
For individual out-of-pocket medical expenses within 50,000 yuan (inclusive), 65% will be paid by the basic medical insurance fund; for individual out-of-pocket medical expenses exceeding 50,000 yuan, 75% will be paid by the basic medical insurance fund.
7. Starting from January 1, 2023, "one-stop" real-time settlement of serious illness medical insurance expenses incurred by participants in this city's basic medical insurance at designated medical institutions will be implemented.
8. This notice will be implemented from January 1, 2023.
If previous regulations are inconsistent with this notice, this notice shall prevail.