Legal subjectivity:

What is included in the basic medical insurance for urban and rural residents is closely related to our daily work or life? Therefore, we cannot only hear about it but not know about it. How exactly is it. 1. Concept The basic medical insurance for urban and rural residents is to integrate the two systems of basic medical insurance for urban and rural residents (referred to as urban resident medical insurance) and new rural cooperative medical care (referred to as new rural cooperative medical care) to establish a unified basic medical insurance for urban and rural residents (referred to as urban and rural resident medical insurance). system. 2. Basic Medical Insurance for Urban Residents Basic Medical Insurance for Urban Residents is a component of social medical insurance. It adopts a government-led financing method with residents’ individual (family) contributions as the mainstay, supplemented by appropriate government subsidies. According to payment standards and benefits A medical insurance system that provides urban residents with medical needs based on the principle of consistent levels. 1. The Urban Residents Basic Medical Insurance Fund is mainly used to pay for inpatient and outpatient serious illness and outpatient rescue medical expenses of insured residents. The payment scope and standards are implemented in accordance with the Urban Residents Basic Medical Insurance Drug Catalog, diagnosis and treatment items and medical service facilities scope and standards. 2. The minimum payment standard (also commonly referred to as the threshold fee) is the same as the urban employee basic medical insurance, that is, 980 yuan for the third level, 720 yuan for the second level, and 540 yuan for the first level. 3. Medical treatment management: Residents covered by the Urban Resident Basic Medical Insurance will implement a designated first-diagnosis and two-way referral system for medical treatment. Community health service centers, specialist hospitals, hospital-store cooperation and secondary and lower medical institutions will be identified as first-diagnosis medical institutions. Some third-level comprehensive and specialized medical institutions are designated as designated referral medical institutions. When insured residents seek medical treatment, they should first seek medical treatment at the designated first-diagnosis medical institution. If their condition truly requires referral for treatment, the designated first-diagnosis medical institution will issue a transfer certificate. Only after this certificate is obtained can the patient be transferred to a designated referral hospital for inpatient treatment. After the condition is relatively stable, the patient should be transferred back to the designated first-diagnosis hospital. (In other words, once you get sick, you must go to a designated community service center hospital or a designated small hospital for treatment. Only when the condition is not cured can the small hospital issue a certificate and be transferred to a large hospital until the condition improves. , I want to move back to live immediately.) 4. Payment ratio: The fund payment ratio is determined according to different levels of medical institutions. The fund payment ratios of first-level (including community health service centers), second-level, and third-level medical institutions are 75%, 60%, 50%. After urban residents have continuously participated in insurance and paid for 2 years, the insurance premiums can be increased to 80%, 65%, and 55% respectively. (In other words, the smaller the hospital you stay in, the more you will be charged) 5. Basic insurance amount: In a natural year, the maximum payment limit of the basic medical insurance co-ordinating fund is 16,000 yuan per person per year. If it is due to patients with chronic renal failure (outpatient dialysis treatment), malignant tumors (outpatient radiotherapy and chemotherapy), organ transplantation and anti-rejection treatment, systemic lupus erythematosus, and aplastic anemia (referred to as "outpatient serious illness"), annual coordination The maximum payment limit of the fund can be increased to 20,000 yuan per person. 3. New Rural Cooperative Medical Care The new rural cooperative medical care (referred to as "New Rural Cooperative Medical Care") refers to the mutual medical assistance for farmers that is organized, guided and supported by the government, with farmers voluntarily participating, with multi-party financing by individuals, collectives and the government, and focusing on overall planning of serious diseases* **Economic system. It raises funds through individual contributions, collective support and government funding. Protection object. The targets of critical illness insurance are insured persons of urban residents' medical insurance and new rural cooperative medical insurance. Coverage. The coverage of critical illness insurance should be connected with urban residents’ medical insurance and new rural cooperative medical insurance. Urban residents' medical insurance and new rural cooperative medical insurance should provide basic medical security in accordance with policy regulations. On this basis, 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. High medical expenses can be judged if the annual cumulative compliant 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 the local government. Compliant medical expenses refer to actual and reasonable medical expenses (matters that may not be paid), which are determined by the local government. Various localities can also launch critical illness insurance starting from diseases with a heavier personal burden. Protection level. With the goal of striving to avoid catastrophic household medical expenses for urban and rural residents, the major illness insurance compensation policy is reasonably determined, and the actual payment ratio is not less than 50%; the payment ratio is formulated according to the level of medical expenses. In principle, the higher the medical expenses, the higher the payment ratio. . With the continuous improvement of financing, management and security levels, the reimbursement ratio for major diseases will be gradually increased to minimize the burden of personal medical expenses. We should make a good connection between basic medical insurance, critical illness insurance and medical assistance for serious and serious diseases, establish a critical illness information notification system, timely grasp the medical insurance payment status of patients with serious illness, strengthen policy linkage, and effectively avoid the problem of poverty due to illness and return to poverty due to illness. 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.