How much is the medical insurance for serious illness? The policy of serious illness medical insurance inherits the purpose of benefiting the people and the people, and continuously increases the liquidation ratio, effectively alleviating the problem of people returning to poverty because of major illness poverty. Next, let's investigate the new policy of serious illness insurance in 217 and the liquidation amount of serious illness medical insurance.
Interpreting the definition of serious illness: from illness to cost
Liang Wannian, full-time deputy director of the State Council medical reform and director of the National Health Planning Commission, said, The former Ministry of Health's New Agricultural Cooperative's major medical insurance starts with diseases, including childhood leukemia, congenital heart disease and other 22 diseases. This opinion clearly requires the occurrence of high medical expenses as the definition standard of major diseases. If the individual pays more than a certain amount, it may cause catastrophic medical expenses in the family, which is a serious illness.
This means that the standard of defining serious illness according to the level of medical expenses and the standard of defining serious illness according to the occurrence of illness has a wide hegemony. There are many beneficiaries, and the payment ratio of insurance is defined according to the level of expenses, so as to give full play to the basic functions of the medical security system.
Interpretation II: The objects of protection are mainly urban residents and the New Agricultural Association
According to the regulations, the objects of serious illness insurance are urban residents' medical insurance and the new agricultural association's insurance (joint). According to relevant personnel, the reimbursement rate of medical insurance for urban employees is high at present, and the maximum payment limit is also high, but the reimbursement rate of urban residents and the New Agricultural Association is relatively high. There are many expenses paid by oneself, and the protection targets are mainly these two types of policyholders.
Individuals with serious illness insurance do not need to pay the expenses, and the funds can be extracted from the additional government funds when raising medical insurance for urban and rural residents annually. You can also allocate a certain proportion (or limit) from the urban residents' medical insurance and the surplus fund of the New Agricultural Association or the urban and rural residents' medical insurance fund.
Interpretation of the proportion of reimbursement for three times: increase by 2% at most
Because the actual settlement ratio of residents' hospitalization medical expenses by the current basic medical insurance for urban and rural residents can reach more than 5%, plus serious illness insurance, In the future, the overall actual settlement ratio of medical expenses for serious illness of urban and rural residents can reach more than 7%. Zhu Ming, director of the Health Economy and Medical Security Research Center of Nankai University, believes that the full implementation of serious illness insurance can effectively alleviate the problems of poverty due to illness.
critical illness insurance system has been piloted in Xinyu and other places in Jiangxi since 213. After the patients of the New Agricultural Association are treated in designated hospitals in the unified area, after the basic medical insurance is settled, The part of individual payment of compliance medical expenses that exceeds the per capita net income of farmers last year is included in the settlement scope of serious illness insurance. Taking Xinyu City as an example, the actual settlement rate of urban and rural residents who enjoy critical illness insurance compensation increased by 15% in 213.
Interpretation of four insurance funds: from the state to pluralism
At present, there are about 7 million people covered by serious illness insurance in China, that is, all urban and rural residents' basic medical insurance participants will be covered by the end of the year. But where does the money come from? It's not enough to rely solely on the state. The method of opinion is to introduce commercial insurance.
In order to encourage commercial insurance institutions to participate in the serious illness insurance service, the opinion is clear. In principle, commercial insurance institutions are selected to undertake the serious illness insurance business through government bidding. The insurance premium income of commercial insurance institutions is exempted from business tax and insurance business supervision fee according to the current regulations.
Interpretation of five guarantee methods: multiple system combination boxing
Of course, The full implementation of serious illness insurance is just a safe, which cannot completely ensure that all seriously ill patients will not incur catastrophic expenses. In this regard, we should clearly put forward opinions and strengthen the connection between different security systems. For example, the complementary linkage between basic medical insurance, serious illness insurance, medical assistance, disease emergency assistance, commercial health insurance and charitable assistance.
For patients who still have difficulties in paying their fees through serious illness insurance, Civil affairs departments and other departments should implement relevant rescue policies in a timely manner. Ma Bin, director of the Institute of Social Security of South China Normal University, believes that this combination boxing will more effectively build an all-round and solid medical security network.
On April 26th, the Municipal Social Insurance Bureau said that it is the implementation of the spirit of the new national policy to adjust the operation of serious illness insurance and explore the feasibility of purchasing services from social forces by using the serious illness insurance fund. It is also to continue to protect the rights and interests of participants in serious illness protection.
Recently, the Dongguan Social Insurance Bureau published the Measures for Medical Insurance for Major Diseases in Dongguan (Draft for Comment), which is referred to as the draft. Compared with the current policy, the payment benchmark, payment ratio and payment limit of medical insurance for serious illness have not changed. The biggest difference is that the draft is put forward. Serious illness medical insurance can be introduced into commercial insurance institutions to participate in business services through bidding.
Serious illness medical insurance does not require additional payment
Dongguan serious illness medical insurance has been implemented since October 213, covering all basic medical insurance participants in the city. According to the Municipal Social Insurance Bureau, the number of people insured for serious illness insurance in the city currently exceeds 6.5 million. As of December 215, The medical insurance for serious illness * * * paid 45 million yuan, with 63, people enjoying the benefits, including 32 million yuan for major illness and 48, people enjoying the benefits. The actual repayment rate of the participants enjoying the medical insurance for serious illness increased by 18 percentage points on average.
According to the current policy in Dongguan, the funds for serious illness insurance were directly transferred from the social basic medical insurance surplus fund in the previous year or previous years, and users and policyholders did not need to pay separately. Insured persons who participate in social basic medical insurance and meet the conditions of social basic medical insurance benefits can also enjoy the treatment of serious illness insurance according to the regulations.
The Municipal Social Insurance Bureau said that Dongguan's serious illness insurance has given full play to the supplementary role of the basic medical insurance system, reduced the economic burden caused by major diseases, effectively alleviated the problem of disease poverty and achieved good social benefits.
According to the current regulations, The rest of the serious illness insurance fund is returned to the social basic medical insurance fund every year. The policy loss of serious illness insurance is first replaced by the accumulated surplus fund of social basic medical insurance, or paid from the serious illness insurance fund in the next year.
Previously, according to media reports, the medical insurance fund in Dongguan is about 2 million to 3 million yuan per year. According to Nanfang Daily, the income of the social basic medical insurance fund in Dongguan in 215 was 4.965 billion yuan. The expenditure was 4.337 billion yuan, with a surplus of 628 million yuan. By the end of 215, the accumulated surplus was 4.946 billion yuan. The reporter found that there was no deficit in the fund for serious illness insurance with reference to the above-mentioned expenditure for serious illness treatment.
The contract period is 3 years in principle.
Then, why should commercial insurance be introduced to undertake serious illness medical insurance? The relevant person in charge of the Municipal Social Insurance Bureau said that on August 2, 215, the Opinions of the General Office of the State Council on Fully Implementing critical illness insurance, an urban and rural resident (hereinafter referred to as the Opinions) required that critical illness insurance should be fully implemented throughout the country, giving full play to the role of market mechanism and the professional advantages of commercial insurance institutions, and improving the operational efficiency, service level and quality of critical illness insurance, and clearly stated that in principle, commercial insurance institutions should be selected to undertake critical illness insurance business through government bidding. If the contractor can't be determined by the normal bidding, the local government shall specify the method for the occurrence of the contractor.
The Municipal Social Insurance Bureau said that the pilot project of serious illness insurance in Dongguan will end on December 31 this year, and Dongguan revised the city's serious illness insurance method according to the requirements of the Opinions, and considered introducing commercial insurance institutions through bidding in the contract of serious illness insurance. Dongguan adjusted the operation of serious illness insurance and explored the feasibility of using the serious illness insurance fund to purchase services from social forces. It is the implementation of the spirit of the national policy, and it is also to continue to protect the rights and interests of participants in serious illness protection.
According to the opinion draft, the cost of purchasing serious illness insurance services should not exceed 3% of the current income of serious illness insurance funds, and the required funds should be extracted from the current serious illness insurance funds. Commercial insurance institutions should provide services according to the contract agreement, and the contract term is 3 years. Commercial insurance institutions should bear the liability for breach of contract if they fail to fulfill the agreement; If the circumstances are serious, the agreement can be terminated. The remaining part of the purchase of the service fee for serious illness insurance can be fully recovered.
The opinion draft also proposes to establish a service quality evaluation mechanism to comprehensively evaluate the service behavior and service quality of commercial insurance institutions. The comprehensive evaluation results are related to the liquidation of the purchase of the service fee for serious illness insurance and the withdrawal mechanism of commercial insurance institutions.
According to the insured's insurance period, the maximum payment limit of Dongguan serious illness medical insurance ranges from 1, yuan to 3, yuan: