217 New Deal for Serious Illness Insurance in Shanghai: The proportion of self-funded reimbursement for four types of diseases was raised to 55%. The reporter learned from the Shanghai Municipal Bureau of Human Resources and Social Security yesterday that in June 214, the Municipal Development and Reform Commission and other six departments issued the Trial Measures for Serious Illness Insurance for Urban and Rural Residents in Shanghai, and the document was valid until December 31, 216. Recently, the city revised and improved the "Trial Measures" and formed the "Measures for Serious Illness Insurance for Urban and Rural Residents in Shanghai", which was officially implemented on January 1 this year. The proportion of self-funded reimbursement for four types of diseases increased from 5% to 55%.

There is no need to pay additional fees

It is understood that according to the new method, the insured persons of the basic medical insurance for urban and rural residents in this city are all applicable to the serious illness insurance for urban and rural residents. This also means that the insured can enjoy the treatment of serious illness insurance for urban and rural residents without paying additional fees after participating in residents' medical insurance on an annual basis.

the municipal bureau of human resources and social security said that residents' serious illness insurance implemented the "community-oriented referral" system. Insured persons suffering from four kinds of serious diseases need to be referred for treatment because of their illness, and they must go through the referral procedures at the community health service center, and then go to the two or three designated medical institutions for medical treatment.

The reimbursement rate is raised to 55%

The newly revised "Measures" focus on improving the level of serious illness protection for urban and rural residents. For four kinds of diseases such as dialysis treatment of severe uremia, anti-rejection treatment of kidney transplantation, malignant tumor treatment and treatment of some mental diseases, the reimbursement rate of serious illness insurance funds for urban and rural residents is raised from 5% to 55%, further reducing the burden of medical expenses for seriously ill patients.

Moreover, the medical expenses incurred by students in colleges and universities in this city due to hemophilia and aplastic anemia are also included in the scope of serious illness insurance for urban and rural residents.

medical insurance fund will raise funds

the funds for serious illness insurance for urban and rural residents will be raised from the medical insurance fund for urban and rural residents in a certain proportion or amount, and the standard for raising funds will be set at about 2% of the total funds raised by the medical insurance fund for urban and rural residents in that year, and it will be allocated by stages.

It is understood that the actual annual fund-raising amount is determined by the Municipal Human Resources and Social Security Bureau in conjunction with the Municipal Finance Bureau and other departments according to the city's economic development level, the fund-raising situation of urban and rural residents' basic medical insurance, the reimbursement level of basic medical insurance, the compensation standard of serious illness insurance and the operation of serious illness insurance funds, and it is reported to the municipal government for approval and implementation.

The reimbursement process remains the same

Considering that since the implementation of the Trial Measures, the insured residents in this city have gradually adapted to the original handling process of applying for residents' serious illness insurance, in order to avoid the inconvenience caused by policy convergence to the insured residents in handling residents' serious illness insurance reimbursement, the newly revised Measures have not adjusted the original handling process, and the insured residents can still apply for reimbursement according to the original process.

after the residents suffer from the above-mentioned serious illness, the expenses incurred in the designated medical institutions of the basic medical insurance in this city that meet the reimbursement scope of the basic medical insurance in this city, after the reimbursement of the basic medical insurance, the expenses borne by the insured residents within the scope of the basic medical insurance policy will be included in the payment scope of the major medical insurance for urban and rural residents, and 55% will be reimbursed by the major medical insurance funds.

if urban and rural residents have participated in the Shanghai medical mutual fund for primary and secondary school students and infants, the part paid by the mutual fund should be deducted first. The insured person shall pay the medical expenses first, and then apply for serious illness compensation to the commercial insurance institution that undertakes the serious illness insurance for urban and rural residents. The commercial insurance institution that undertakes shall provide serious illness compensation services for the insured person in time.

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