20 17 interpretation of serious illness insurance policy how much is the reimbursement for serious illness medical insurance?

20 17 interpretation of critical illness insurance policy what is the cost of critical illness medical insurance? The medical insurance policy for serious illness adheres to the purpose of benefiting the people and the people, and continuously increases the liquidation ratio, effectively alleviating the problem of people returning to poverty due to serious illness. Next, let's investigate the new policy of critical illness insurance in 20 17 and the liquidation amount of critical illness medical insurance.

Interpretation of the definition of serious illness: from disease to cost

Liang Wannian, full-time deputy director of the State Council Medical Reform and director of the National Health Planning Commission, said that the major medical security of the former Ministry of Health's new rural cooperative medical system began with diseases, including 22 diseases such as childhood leukemia and congenital heart disease. This opinion clearly requires the occurrence of high medical expenses as the definition standard of major diseases. If an individual pays more than a certain amount, it may cause catastrophic medical expenses to the family, which is a serious illness.

This means defining the standard of serious illness according to the level of medical expenses, defining the standard of serious illness according to the level of illness, with wide hegemony and many beneficiaries, and defining the payment ratio of insurance according to the level of expenses, so as to effectively play the basic functions of the medical security system.

Interpretation 2: Security targets: mainly urban residents and the new rural cooperative medical system.

According to the regulations, serious illness insurance covers urban residents' medical insurance and new rural cooperative medical insurance. According to relevant personnel, at present, the reimbursement rate of medical insurance for urban workers is high, and the maximum payment limit is also high. However, the reimbursement rate of urban residents and the new rural cooperative medical system is relatively low, and more expenses are paid. The protection targets are mainly these two types of policyholders.

Individuals with serious illness insurance don't need to pay, and the funds can be drawn from the government funds added when raising medical insurance for urban and rural residents every year, or a certain proportion (or limit) can be drawn from the balance funds of medical insurance for urban residents and the new rural cooperative medical system or the medical insurance fund for urban and rural residents.

Interpretation of the proportion of three reimbursements: up to 20%

At present, the actual settlement ratio of urban and rural residents' basic medical insurance to residents' hospitalization medical expenses can reach more than 50%, and with the serious illness insurance, the overall actual settlement ratio of urban and rural residents' serious illness medical expenses can reach more than 70% in the future. Zhu Ming, director of the Center for Health Economy and Medical Security of Nankai University, believes that the comprehensive implementation of serious illness insurance can effectively alleviate the problem of poverty caused by illness.

Xinyu and other places in Jiangxi Province began to pilot the serious illness insurance system from 20 13. The patients of the new rural cooperative medical system have been treated in the designated hospitals in the unified area. After the settlement of basic medical insurance, the part of the compliance medical expenses paid by individuals that exceeds the per capita net income of farmers in the previous year shall be included in the settlement scope of serious illness insurance. Taking Xinyu City as an example, the actual settlement rate of urban and rural residents who enjoyed serious illness insurance compensation in 2065438 was +05%.

Interpretation of the Four Major Insurance Funds: From State to Pluralism

At present, the number of people covered by serious illness insurance in China has reached about 700 million. By the end of the year, full coverage of serious illness insurance will be achieved, that is, all urban and rural residents will participate in basic medical insurance. But where does the money come from? It is not enough to rely solely on the state. The suggested way is to introduce commercial insurance.

In order to encourage commercial insurance institutions to participate in major illness insurance services, the opinions are clear. In principle, commercial insurance institutions are selected to undertake serious illness insurance business through government bidding. The premium income of commercial insurance institutions undertaking serious illness insurance shall be exempted from business tax and insurance business supervision fee according to the current regulations.

Interpretation of Five Guarantees: Multi-system Combination Boxing

Of course, the comprehensive implementation of critical illness insurance is only a safe, and it cannot completely guarantee that all patients with critical illness will not have catastrophic expenses. In this regard, we should clearly put forward opinions and strengthen the connection between different security systems such as basic medical insurance, serious illness insurance, medical assistance, emergency medical assistance, commercial health insurance and charitable assistance.

For patients who still have difficulties in paying through serious illness insurance, civil affairs departments and other departments should implement relevant rescue policies in a timely manner. Ma Bin, director of the Institute of Social Security of South China Normal University, believes that this combination boxing will more effectively build an all-round and three-dimensional medical security network.

On April 26th, the Municipal Social Insurance Bureau stated that Dongguan's adjustment of the operation mode of serious illness insurance and exploration of the feasibility of using the serious illness insurance fund to purchase services from social forces are to implement the spirit of the new national policy, and also to continue to protect the rights and interests of seriously ill insured persons.

A few days ago, Dongguan Social Insurance Bureau announced the "Measures for Medical Insurance for Serious and Serious Diseases in Dongguan (Draft for Comment)", referred to as the draft. Compared with the current policy, the payment basis, payment ratio and payment limit of serious illness medical insurance have not changed. The biggest difference is that the draft proposes that serious illness medical insurance can be introduced into commercial insurance institutions to participate in business services by bidding for services.

Medical insurance for critical illness does not need to be paid separately.

The medical insurance for serious illness in Dongguan has been implemented since June 20 13, covering all participants in the city's basic medical insurance. According to the introduction of the Municipal Social Insurance Bureau, the number of people participating in serious illness insurance in the city currently exceeds 6.05 million. By February of 20 15, 450 million yuan had been paid for medical insurance for serious illness, and 63,000 people were entitled to treatment.

According to the current policy in Dongguan, serious illness insurance funds are directly transferred from the social basic medical insurance balance funds in the previous year or previous year, and users and policyholders do not need to pay separately. If the insured participates in social basic medical insurance and meets the conditions of social basic medical insurance, he can also enjoy the treatment of serious illness insurance according to the regulations.

According to the Municipal Social Insurance Bureau, the major illness insurance in Dongguan has fully played the supplementary role of the basic medical insurance system through the pilot in the past two years, which has reduced the economic burden caused by major diseases, effectively alleviated the problem of disease poverty and achieved good social benefits.

According to the current regulations, the remaining part of the serious illness insurance fund is returned to the social basic medical insurance fund every year. The policy loss of serious illness insurance is replaced by the accumulated balance fund of social basic medical insurance first, or paid from the serious illness insurance fund in the next year.

Earlier, according to media reports, the medical insurance fund in Dongguan was about 200 million to 300 million yuan per year. According to Nanfang Daily, the income of social basic medical insurance fund in Dongguan in 20 15 was 4.965 billion yuan, and the expenditure in that year was 4.337 billion yuan. By the end of 20 15, the accumulated surplus was 4.946 billion yuan. The reporter found that with reference to the above,

The term of the contract is 3 years in principle.

Then, why should commercial insurance be introduced to undertake serious illness medical insurance? The relevant person in charge of the Municipal Social Insurance Bureau said that on August 2, 20 15, the Opinions of the General Office of the State Council on the Full Implementation of Serious Illness Insurance for Urban and Rural Residents (hereinafter referred to as the Opinions) required that serious illness insurance should be fully implemented nationwide, and the professional advantages of market mechanism and commercial insurance institutions should be brought into play to improve the operational efficiency, service level and quality of serious illness insurance. It is clearly pointed out that in principle, commercial insurance institutions should be selected to undertake serious illness insurance business through government bidding. If the contracting institution cannot be determined through normal bidding, the local government will designate the contracting institution.

According to the news of the Municipal Social Insurance Bureau, the trial of serious illness insurance in Dongguan will end on June 5438+February 3 1 this year. According to the "Opinions", Dongguan will revise the city's major illness insurance measures and consider inviting tenders to introduce commercial insurance institutions into major illness insurance contracts. Adjusting the operation of Dongguan's serious illness insurance and exploring the feasibility of using the serious illness insurance fund to purchase services from social forces are the implementation of the spirit of the national policy and also to continue to protect the rights and interests of the insured.

According to the opinion draft, the cost of purchasing serious illness insurance service shall not exceed 3% of the current income of the serious illness insurance fund. The current calculation, the required funds should be extracted from the current serious illness insurance fund. Commercial insurance institutions should provide services according to the contract, and the contract period is 3 years. If a commercial insurance institution fails to perform the contract, it shall bear the liability for breach of contract; If the circumstances are serious, the agreement may be terminated. The rest of the service fee for purchasing serious illness insurance will be fully recovered.

The opinion draft also proposes to establish a service quality evaluation mechanism to comprehensively evaluate the service behavior and service quality of commercial insurance institutions. The comprehensive evaluation results are related to the liquidation of purchasing serious illness insurance service fees and the withdrawal mechanism of commercial insurance institutions.

According to the insured's insurance period, the maximum compensation limit of Dongguan critical illness medical insurance ranges from 6,543,800 yuan to 300,000 yuan: