This paper carefully arranges the items and scope of reimbursement ratio of medical insurance for urban residents in Shaanxi Province. Since this policy has not been officially updated, the following latest version of the policy is used.
The six ministries and commissions of the state officially promulgated the Guiding Opinions on Carrying out Serious Illness Insurance for Urban and Rural Residents, clearly stating that the actual reimbursement ratio of serious illness medical insurance is not less than 50%; Five days later, the large-scale insurance for urban and rural residents nationwide was officially launched. If the medical expenses of urban residents in our province exceed the per capita disposable income of urban residents in the previous year, the per capita net income of rural residents can be subsidized according to large insurance.
The reporter learned from the Shaanxi Provincial Department of Human Resources and Social Security that before the state announced the preferential policies, Mr. Ji, Ankang and Xianyang of our school had taken the lead in exploring large-scale medical subsidies and rescue methods. Among them, the large-scale Medicaid for urban residents in Xianyang City stipulates that 80% of hospitalization expenses can be paid by large-scale Medicaid funds, and 90% of insured persons with difficulties can be paid by large-scale Medicaid funds.
Shaanxi medical insurance "blueprint"
The reimbursement rate of basic medical insurance for urban residents is "stepped"
In 2007, our province issued a policy to start the pilot of basic medical insurance for urban residents. In 2008, the whole province was fully opened. In 2009, our province included college students in the scope of medical insurance for urban residents. By the end of last year, the number of urban residents participating in basic medical insurance in the province had reached10.905 million, and the participation rate reached 96%, including 5.403 million urban employees and 5.502 million residents. It is understood that the highest payment limit and reimbursement ratio of the medical insurance pooling fund in our province have steadily increased. At the beginning of 2007, the reimbursement rate of hospitalization expenses in the basic medical insurance policy for urban residents was 50%, and now it has reached about 70%.
Urban medical insurance system to achieve full coverage of the population
The coverage of basic medical insurance for urban residents in our province is not wide. Non-employed urban residents, flexible employees, migrant workers, college students, students in primary and secondary schools (including vocational high schools, technical secondary schools and technical schools) and children (including children of migrant workers who have been studying and living in cities with their parents for a long time) who are not included in the basic medical insurance system for employees can voluntarily participate in the insurance. Anyone who participates in the basic medical insurance for urban residents shall be subsidized by governments at all levels according to certain standards. Adults only need to pay 120 to 200 yuan, and students and children only need to pay 10 to 30 yuan to enjoy residents' medical insurance reimbursement. Financial subsidies for the insured at all levels have increased from 40 yuan per capita in 2007 to 250 yuan per capita now, exceeding the national standard of 240 yuan per capita, effectively promoting the improvement of residents' basic medical insurance benefits.
On this basis, the financial departments at all levels will give subsidies to students and children who belong to the minimum living allowance or severely disabled for the part of family contributions, according to each person 10 yuan; For other low-income residents, severely disabled people who have lost their ability to work, low-income families, elderly people over 60 years old and other difficult urban residents, the family contributions required for insurance are subsidized by governments at all levels, and each person subsidizes 60 yuan.
Serious illness medical insurance "exploring the road"
The highest proportion of serious illness relief in Ankang City is 60%
In fact, before the country announced the new policy of serious illness medical insurance, our teachers, Ji, Ankang and Xianyang had taken the lead in "exploring the road" for residents' serious illness medical insurance, and had taken the lead in introducing relevant measures according to the actual situation of each city.
The reporter learned that Ankang City has begun to try out the medical insurance measures for urban residents' serious illness relief, and the insured residents will no longer pay from the medical insurance fund according to the 20 yuan per person. In an insured year, after the insured patients are reimbursed according to the provisions of the basic medical insurance for urban residents, if their medical expenses are more than 6,000 yuan, they will be rescued by 30% to 1000 yuan, 40% to 30,000 yuan, and 50% to 60,000 yuan, with a maximum limit of 60,000 yuan.
Xianyang large Medicaid fund pays 90%.
Xianyang City has also followed up with the introduction of large medical subsidies for urban residents. The standard for raising large-scale Medicaid funds is to extract insured residents from the medical insurance fund for each person and each 20 yuan, without paying fees. The annual maximum payment limit of large-scale Medicaid is 50,000 yuan, of which the annual maximum payment limit of large-scale Medicaid fund for "three noes" personnel, disabled persons who have lost their ability to work, severely disabled persons, low-income families and those who enjoy the minimum living guarantee is 654.38+10,000 yuan. Included in the scope of large Medicaid funds to pay for hospitalization expenses, large Medicaid funds to pay 80%, difficult insured large Medicaid funds to pay 90%.
The introduction of big wave sales standards in our province is just around the corner.
The Shaanxi Provincial Department of Human Resources and Social Security said that at present, the detailed rules for compensation for major diseases and diseases are being intensively discussed and studied in our province, and the specific implementation methods and reimbursement standards will be formulated according to the national guidance.