Medical mutual aid for serious illness refers to a social medical mutual aid system established by urban workers on the basis of participating in basic medical insurance to solve the problem that the insured patients exceed the maximum payment limit of the basic medical insurance pooling fund and ensure the medical needs of employees for serious illness. The employer shall pay the medical mutual aid fee for serious illness for 6 months at the time of enrollment, and pay it monthly from the seventh month. Insured employees enjoy mutual medical treatment for serious illness from the next month of insurance payment.
The following is for reference only.
From the current 3.4% to 4%, the Qifubiaozhun for the first hospitalization of the insured will be lowered to 200 yuan within one medical settlement year. Terminal cancer patients, vegetarians, etc. If you have difficulty in hospitalization, you can apply to the municipal medical insurance center for opening a family bed. After the application is approved, according to the standard limit of 50 yuan/day, the overall fund will pay 90%, and the insured will be responsible 10%. During the opening of family sickbeds, outpatient medical treatment for special diseases will be stopped.
Qifubiaozhun for hospitalization will be lowered across the board.
Reduce the minimum threshold for the first hospitalization of the insured within one medical settlement year, and the first, second and third level hospitals will be reduced from the original 686.4 yuan, 858 yuan,115.4 yuan to 486.4 yuan, 658 yuan and 9 15.4 yuan respectively. For the second hospitalization, the Qifubiaozhun is paid at 50% of the adjusted new standard, and for the third and above hospitalization, the Qifubiaozhun is paid at 30% of the new standard.
If the hospitalization fee exceeds 30,000, you can enjoy medical assistance for serious illness.
The new policy has adjusted the payment section and payment ratio of the mutual medical fund for serious illness. The starting point of medical mutual aid payment for serious illness was reduced from 40,000 yuan to 30,000 yuan, and the capping line for serious illness was adjusted from 1 1 10,000 yuan to10.5 million yuan. Within the limit of mutual medical assistance payment for serious illness, the proportion of individual conceit has been reduced from the original 10% to 6%. The relevant staff of Changsha Medical Insurance Center pointed out that this measure can make the serious illness medical mutual fund play a greater role in ensuring the hospitalization expenses of more than 30,000 yuan, and the insured patients can immediately enjoy the protection of the serious illness medical mutual fund.
Retirees' personal accounts are more substantial.
According to reports, an important measure to adjust the relevant treatment of basic medical insurance this time is to enrich the personal accounts of retirees, and the proportion of medical insurance funds transferred to the personal accounts of retirees has increased from the current 3.4% to 4%. At present, there are 206,000 retirees in this city, and the per capita monthly income is 36 1 yuan according to the current base. Regardless of the number of retirees and the growth of the base, it will increase by 0.6%, and each person will increase 76 yuan every year. The medical insurance pooling fund needs to increase its expenditure by about 654,380+0,566 yuan.
7 included in the special outpatient medical diseases
Some patients with special diseases need long-term medication and treatment, and the burden is heavy. In order to solve the practical difficulties of these people, seven diseases, such as demyelinating diseases of central nervous system, myasthenia gravis, pituitary adenoma, hepatolenticular degeneration, systemic sclerosis, Crohn's disease and epilepsy, were included in the special outpatient medical diseases. Within the limit of outpatient medical payment for special diseases, the insured patients bear 20% individually and the medical pooling fund pays 80%. At the same time, improve the outpatient medical payment standard for hypertension, coronary heart disease, Parkinson's syndrome and psychosis. After transplantation, the original limited drug variety was changed to a limited reimbursement amount: 4,500 yuan per month within six months after transplantation and 4,000 yuan per month after six months.
Medical mutual aid for serious illness refers to a social medical mutual aid system established by urban workers on the basis of participating in basic medical insurance to solve the problem that the insured patients exceed the maximum payment limit of the basic medical insurance pooling fund and ensure the medical needs of employees for serious illness. The employer shall pay the medical mutual aid fee for serious illness for 6 months at the time of enrollment, and pay it monthly from the seventh month. Insured employees enjoy mutual medical treatment for serious illness from the next month of insurance payment.
What is the basic medical insurance system for urban workers?
The basic medical insurance system for urban employees is a social medical insurance system that guarantees the basic medical rights of employees according to law, and is enforced by laws and regulations. The basic mode of combining social pooling medical fund with individual medical account is the basic insurance item of social insurance, just like pension, work injury, unemployment and maternity insurance. Where the urban employers and their employees within the jurisdiction of this Municipality must participate in the basic medical insurance for employees in Changde City in accordance with the Trial Measures for the Basic Medical Insurance for Urban Employees (Chang [1999] No.21) and its supporting documents issued by the Municipal People's Government.