The new policy of serious illness medical insurance for urban and rural residents, which is equivalent to "secondary reimbursement", is about to take root in various places.

Six ministries and commissions including the National Development and Reform Commission, the Ministry of Human Resources and Social Security, and the Ministry of Health jointly issued the "Guiding Opinions on Carrying out Critical Illness Insurance for Urban and Rural Residents" yesterday. Based on the basic medical insurance for urban and rural residents and the new rural cooperative medical insurance, the personal burden after medical insurance reimbursement will be re-examined.

Reimbursement, the reimbursement ratio will not be less than 50%.

It is reported that various localities will launch new policies based on local conditions, and the reimbursement ratio will be calculated based on the level of medical expenses. In principle, the higher the medical expenses, the higher the reimbursement ratio.

The so-called "resident critical illness medical insurance" refers to the "secondary reimbursement" for the excessive medical burden caused by major diseases on the insured on the basis of the existing reimbursements of urban and rural residents' medical insurance and new rural cooperative medical insurance.

The insured objects are the insured persons of urban resident medical insurance and new rural cooperative medical insurance.

Reimbursement ratios and specific reimbursement policies should be adapted to local conditions. Regarding insurance premiums, the opinion does not set unified requirements. It only requires in principle that all localities should take into account the local economic and social development level, medical insurance financing capabilities, high medical expenses for serious illnesses, and basic medical insurance reimbursement levels.

As well as factors such as the level of critical illness insurance protection, we can make precise calculations on our own to scientifically and reasonably determine the financing standards for critical illness insurance.

The opinion is clear that critical illness insurance mainly protects the qualified medical expenses that need to be borne by the individual after compensation from urban residents' medical insurance and New Rural Cooperative Medical Insurance when the insured person suffers from a serious illness and incurs "high medical expenses."

The so-called "high medical expenses" can be judged when the annual cumulative medical expenses borne by an individual exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents published by the local statistics department. The specific amount is determined by each locality.

The government is determined.

The so-called "compliant medical expenses" refer to actual and reasonable medical expenses, which are determined by the local government.

The opinions suggest that various localities can develop critical illness insurance starting from diseases with heavier personal burdens.

The opinion is clear that the specific reimbursement policy can be adapted to local conditions, but the actual payment ratio should not be less than 50%; and the payment ratio is set according to the level of medical expenses. In principle, the higher the medical expenses, the higher the payment ratio, in order to "strive to avoid family accidents among urban and rural residents."

Catastrophic Medical Expenditures.”

The "Resident Critical Illness Medical Insurance" will be purchased from commercial insurance companies through government bidding, and commercial insurance institutions will be selected to purchase critical illness insurance from them.

The tenderer shall sign an insurance contract with the winning commercial insurance institution to clarify the responsibilities, rights and obligations of both parties. The cooperation period shall in principle be no less than 3 years.

Commercial insurance companies participating in the bidding must meet requirements such as "operating special health insurance business in China for more than 5 years" and "having full-time staff with professional backgrounds such as medicine."

All localities must follow the principles of balancing revenue and expenditure, maintaining principal and making small profits, reasonably control the profitability of commercial insurance institutions, and establish assessment methods that focus on the level of protection and the satisfaction of insured (partners).

Due to violation of the contract or other serious damage to the rights and interests of the insured (partner), both parties to the contract may terminate or terminate the cooperation in advance and be held accountable in accordance with the law.

Sources of Funds: Medical Insurance Fund + New Rural Cooperative Medical Care Fund The opinions require that a certain proportion or amount be allocated from the Urban Resident Medical Insurance Fund and the New Rural Cooperative Medical Care Fund as critical illness insurance funds.

Areas with surpluses in urban residents' medical insurance and new rural cooperative medical insurance funds should use the surplus to raise funds for critical illness insurance; areas with insufficient or no surplus should coordinate the sources of funds during the annual increase in financing for urban residents' medical insurance and new rural cooperative medical insurance, and gradually improve urban residents' medical insurance.

, New Rural Cooperative Medical Care multi-channel financing mechanism.

In terms of coordination level and scope, localities can coordinate at the city (prefecture) level, or explore unified policies across the province (districts and cities), organize and implement them uniformly, and improve their ability to resist risks.

Where conditions permit, we can also explore the establishment of a unified critical illness insurance system covering employees, urban residents, and rural residents.

According to the requirements, all localities will also do a good job in connecting basic medical insurance, critical illness insurance and medical assistance for serious and serious diseases, establish a critical illness information reporting system, timely grasp the medical insurance payment status of patients with serious illness, strengthen policy linkage, and effectively avoid poverty due to illness or return to poverty due to illness.

question.

The designated medical institutions, medication and diagnosis and treatment scope for urban and rural medical assistance shall be implemented in accordance with the relevant policies and regulations of basic medical insurance and critical illness insurance respectively.

The city’s focus on Beijing’s “secondary reimbursement” is wider. According to the city’s People’s Insurance Department, the city’s “critical illness medical insurance” policy is being stepped up and is expected to be released within the next month or two.

It is reported that this city’s “secondary reimbursement” policy will be more “powerful” than the national policy and will cover a wider scope. It may be based on the urban residents’ medical insurance and the new rural cooperative medical insurance and cover a larger number of employees.

Medical insurance.

According to the work plan of the Municipal People's Insurance Bureau, the city will establish "supplementary medical measures for serious and serious diseases" within the year, focusing on solving the problem of insured persons suffering from malignant tumors, leukemia, organ transplantation and other major diseases who have a heavy medical cost burden within the basic medical insurance system.

solve the problem and alleviate the burden on families who “fall into poverty due to illness” or “return to poverty due to illness”.