At present, our country is vigorously promoting the critical illness insurance system, whose purpose is to solve the problem of people's difficulty in seeking medical treatment and reduce the pressure on people to see a doctor.

In order to expand the scope of insurance and achieve universal coverage, the Chinese government stipulates that employers must participate in medical insurance for their employees in accordance with regulations.

At the same time, urban and rural residents can voluntarily participate in resident medical insurance according to their own circumstances.

Now we will introduce to you the new policy of Weihai residents’ critical illness insurance in 2017.

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A few days ago, the Weihai Municipal Human Resources and Social Security Bureau issued the "Notice of Weihai Municipal Human Resources and Social Security Bureau and other five departments on doing a good job in critical illness insurance for employees and residents in 2017".

The content is as follows: 1. Basic policies (1) Establishing an employee critical illness insurance system. The city has uniformly established and implemented an employee critical illness insurance system since 2017.

Employee critical illness insurance is implemented as a province-wide plan, with unified financing standards, unified payment policies, and unified handling procedures.

The objects of protection are employees and retirees who participate in the basic medical insurance for employees and enjoy medical treatment in accordance with regulations.

The financing standard in 2017 is 20 yuan per person per year, which is allocated from the employee basic medical insurance fund, and individuals do not pay.

The coverage covers the compliant medical expenses incurred by employees during the year when they use special drugs (hereinafter referred to as special drugs) uniformly stipulated by the Shandong Provincial Department of Human Resources and Social Security.

The guarantee standard is a minimum payment standard of 20,000 yuan, and 60% compensation will be given for the portion above the minimum payment standard (including 20,000 yuan).

Within a medical year, each person will receive a maximum compensation of 200,000 yuan.

(2) Improve the resident critical illness insurance policy. In 2017, the financing standard for resident critical illness insurance was increased to 62 yuan per person per year.

Improve the protection benefits of residents' critical illness insurance. On the basis of maintaining the current policy unchanged, the compliant medical expenses incurred by residents using special drugs uniformly stipulated by the Shandong Provincial Department of Human Resources and Social Security during the year will be included in the scope of protection and will be compensated separately.

The guarantee standard is a minimum payment standard of 20,000 yuan (there is no minimum payment standard for registered rural poor people), and 40% compensation will be given for the portion above the minimum payment standard.

Within a medical year, each person will receive a maximum compensation of 200,000 yuan.

Measures for the management and service of critical illness insurance special drugs for employees and residents shall be formulated separately by the municipal human resources and social security departments.

2. Handling services The handling and management of critical illness insurance for employees and residents shall be led by the government and undertaken by commercial insurance institutions.

In 2017, the city's critical illness insurance for employees and residents was uniformly undertaken by the Weihai Branch of China Life Insurance Co., Ltd.

The municipal human resources and social security department signed an undertaking agreement with the undertaking commercial insurance institution to clarify the rights and obligations of both parties, and allocated 80% of the total funds to the designated account of China Life Insurance Co., Ltd. Shandong Branch before the end of July.

The remaining 20% ??will be allocated in time according to the provincial requirements.

Both parties should strengthen connection and cooperation, and conscientiously do a good job in insurance payment, fund transfer, financial management, payment and settlement, expense review, system docking and information exchange.

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Commercial insurance institutions must formulate work plans and implement responsibility measures in accordance with the undertaking requirements, implement separate accounting and special account management of premiums obtained from handling critical illness insurance, ensure fund security, and ensure solvency.

Vigorously promote the immediate settlement of medical expenses for critical illness insurance and basic medical insurance; for medical expenses that cannot be settled immediately, commercial insurance institutions must improve the service process and carry out solid review and reimbursement work to ensure timely reimbursement, accurate payment, and efficient service

, the revenue and expenditure operations, expense compensation and other relevant information of critical illness insurance must be regularly reported to the human resources and social security departments at all levels, and disclosed to the public to accept social supervision.

When families with financial difficulties apply for medical assistance, commercial insurance institutions must issue standardized reimbursement certificates in a timely manner.

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3. Organization and Implementation All districts and cities must attach great importance to critical illness insurance for employees and residents, effectively strengthen leadership, clarify the division of labor, and implement responsibilities.

All relevant departments must strengthen cooperation, form synergy, guide publicity, and ensure that policies are implemented in place.

Human resources and social security departments at all levels should strengthen the coordination, guidance, supervision and management of critical illness insurance handling business, and do a good job in tracking and analyzing the operation of the system.

The civil affairs department is responsible for connecting the medical assistance system with the basic medical insurance and critical illness insurance systems, so as to play a synergistic and complementary role and effectively reduce the medical expense burden of insured persons.

The financial department is responsible for cooperating with the human resources and social security departments to strengthen the management of basic medical insurance funds and allocate critical illness insurance funds in a timely manner.

The health and family planning department must strengthen supervision of the service behavior of medical institutions and medical personnel, and control unreasonable expenditures on medical expenses.