Medical insurance covers serious illness in Chengdu.

Medical insurance covers serious illness in Chengdu.

From July 1 day, our city will raise the level of supplementary medical insurance for serious and serious diseases, and the highest payment ratio can reach 90%!

In order to prevent poverty caused by illness, the General Office of Chengdu Municipal Government issued the Notice on Perfecting the Medical Insurance System for Serious and Extraordinary Diseases, and supplemented the medical insurance for serious and extraordinary diseases to improve the level of protection for serious and extraordinary diseases.

Before the promulgation of the "Notice", the reimbursement rate of urban workers who met the reimbursement scope of supplementary medical insurance for serious illness in Chengdu was 77%. The notice made it clear that the supplementary insurance fund for serious illness medical mutual assistance should be paid in stages and in proportion. Insured persons who pay at two different rates are divided into four different grades and reimbursed according to different proportions. The maximum payment ratio is 90%.

After improving the level of security, the rest will be reimbursed in the basic medical insurance.

The payment ratio can reach up to 90%

The "Notice" proposes to improve the level of protection for critical illness by supplementary medical insurance for critical illness. According to the "Notice", the insured who participated in the supplementary medical insurance for serious illness in our city, the medical expenses incurred after suffering from serious illness, the remaining part after reimbursement within the scope of the basic medical insurance policy, and the one-time hospitalization expenses that meet the reimbursement scope of the supplementary medical insurance for serious illness will be paid by the supplementary medical insurance fund for serious illness in stages and in proportion.

The "Notice" clarifies that the insured who voluntarily participated in the basic medical insurance for urban workers and 80% of the average salary of employees in the city in the previous year will participate in the supplementary medical insurance for serious illness according to the payment ratio of 1%, and pay the following proportion: 1 10,000 yuan (including 1 10,000 yuan), and 77% will pay the rest;

The remaining 80% is paid between 10000 yuan and 30000 yuan (including 30000 yuan); The remaining 85% will be paid between 30,000 yuan and 50,000 yuan (including 50,000 yuan); The remaining 90% is paid above 50,000 yuan.

80% of the average salary of employees in the city in the previous year is the base of payment, and the insured who participated in the supplementary medical insurance for serious illness at the rate of 0.5% will pay according to the following proportions: 10000 yuan (including 10000 yuan), and the remaining 38.5%;

Pay 40% of the rest between 10000 yuan and 30000 yuan (including 30000 yuan); The remaining 42.5% is paid between 30,000 yuan and 50,000 yuan (including 50,000 yuan); The remaining 60% will be paid above 50,000 yuan.

Improve the security system and provide basic medical insurance for the insured.

The maximum drug fee paid in a treatment year is 6.5438+0.5 million yuan.

The Notice proposes to improve the medical insurance system for serious and serious diseases. Establish a list of medical insurance drugs for serious and serious diseases. Drugs entering the list of drugs for serious and serious diseases should fully consider the affordability of the supplementary insurance fund for medical assistance for serious and serious diseases and the personal burden of patients, and meet the following basic conditions: they are not covered by the basic medical insurance; Clinical necessity, exact curative effect and heavy personal burden; Drug indications and clinical diagnosis and treatment norms are clear; Drug manufacturers or drug suppliers voluntarily negotiate with medical insurance agencies and promise to guarantee the supply of drugs.

In terms of financing medical insurance for serious and serious diseases, the Notice clarifies two financing standards. Specifically, first of all, those who participate in the basic medical insurance for urban workers in our city (excluding hospitalization as a whole) and voluntarily pay 80% of the average wage of workers in the city for more than one year, and participate in the supplementary medical insurance for serious illness at the payment ratio of 1% or 0.5%, will be directly included in the medical insurance coverage for serious and serious diseases, and will not be paid separately.

At the same time, the insured who participated in the basic medical insurance for urban and rural residents in our city and participated in the basic medical insurance for urban workers in our city by hospitalization as a whole will pay the medical insurance premium for serious and serious diseases at 20% of the low-grade payment standard for individual basic medical insurance for urban and rural residents, and individuals will pay it together when paying the basic medical insurance premium. The basic medical insurance fund for serious illness raised by the above two standards is included in the management of supplementary medical insurance fund for serious illness.

In addition, in terms of the payment standard of medical insurance for serious and serious diseases, the medical expenses incurred by the insured who participate in the basic medical insurance in our city that meet the payment conditions of the list of serious illness drugs and are within the validity period of medical insurance benefits are paid by the supplementary insurance fund for serious illness medical assistance according to the standard of 70%, and the accumulated medical expenses in the list of serious illness drugs paid by the supplementary insurance fund for serious illness medical assistance in a treatment year do not exceed 1.5 million yuan.

It should be noted that under any of the following circumstances, the expenses incurred by the insured participating in the basic medical insurance in our city for using the drugs in the list of critically ill drugs will not be paid by the Supplementary Insurance Fund for Mutual Assistance in Critical Illness Medical Care: the diagnosis conclusion issued by the medical institution is inconsistent with the legal instructions for drug use, or it is inconsistent with the provisions of the list of critically ill drugs; Buying drugs in non-designated medical institutions and non-designated retail pharmacies; There is no prescription from the responsible doctor; Persons who participated in the basic medical insurance for urban workers in our city as individuals have participated in the supplementary medical insurance for serious illness for less than 12 months.

Extended reading:

The proportion of medical insurance payment for serious illness in Chengdu has increased.

According to the introduction of Chengdu Municipal Bureau of Human Resources and Social Security, in order to prevent poverty caused by illness, the General Office of Chengdu Municipal Government issued the Notice on Improving the Medical Insurance System for Serious and Extraordinary Diseases, which improved the level of protection for serious and extraordinary diseases, and the payment ratio increased from the original maximum of 77% to 90%.

Li, director of the Urban and Rural Medical Insurance Department of Chengdu Municipal Bureau of Human Resources and Social Security, introduced that the medical expenses of the insured who participated in Chengdu's supplementary medical insurance for serious illness were first reimbursed within the scope of the basic medical insurance policy, and the rest after reimbursement was in line with the reimbursement scope of supplementary medical insurance for serious illness. It was paid by supplementary medical insurance for serious illness.

Before the promulgation of this notice, the highest reimbursement rate of urban workers who meet the reimbursement scope of supplementary medical insurance for serious illness in Chengdu was 77%.

This notice makes it clear that according to the actual payment of the insured, there are four different levels, and the supplementary insurance funds for serious illness medical assistance are reimbursed according to different proportions.

Among them, the insured who participates in the basic medical insurance for urban employees and voluntarily takes 80% of the average salary of employees in this city for more than one year as the payment base, and participates in the supplementary medical insurance for serious illness according to the payment ratio of 1%, the maximum payment ratio of one-time hospitalization expenses is 90%.

The notice also stipulates that the expenses incurred by the insured to participate in the basic medical insurance that meet the payment conditions of the list of serious illness drugs and are within the validity period of the medical insurance benefits shall be paid by the mutual medical insurance for serious illness according to the standard of 70%, and the accumulated medical expenses paid within one treatment year shall not exceed 6,543,800 yuan+0.5 million yuan.

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