How to handle the serious illness subsidy in Dalian?

1. How to handle medical insurance assistance for serious illness in Dalian?

(1) I fill out the Personal Application Form for Outpatient Diagnosis of Special Diseases (in duplicate);

(2) Submit the completed application form, recent discharge records, outpatient medical records, relevant inspection materials and one-inch photos to the unit;

(3) The unit shall affix its seal to confirm and report to the municipal medical insurance center for approval.

Among them, the insured person who applies for chemotherapy and radiotherapy for malignant tumor, chemotherapy for leukemia, dialysis treatment for uremia and anti-rejection treatment for organ transplantation can apply for business by himself or his family. Upon examination and verification, it is confirmed that the application materials of the insured are true and complete, and the conditions of the applied diseases meet the requirements, and the Outpatient Serious Illness Medical Certificate shall be given, and the start time of annual outpatient serious illness medical treatment shall be determined according to the date of examination and approval, and the designated hospitals for outpatient serious illness medical treatment shall be determined according to my requirements. The applicant's unit shall promptly go to the municipal medical insurance management center to retrieve all the information within the prescribed time limit.

Only one designated outpatient hospital with serious illness can be selected, and it shall not be changed within one medical year; "Outpatient medical certificate for serious illness" is valid for one year, and the annual inspection shall be conducted in the month when the medical year expires; The application for increasing diseases shall be handled according to the initial application procedure.

Two, Dalian medical insurance reimbursement guide

The Measures for the Implementation of Serious Illness Insurance for Urban Residents in Dalian will take effect on June 5438+1 October1. Individuals who participate in insurance will not pay extra fees. After enjoying the basic medical insurance reimbursement, the accumulated personal burden exceeds 16500 yuan, which can be reimbursed by the serious illness insurance by 50% to 70%, and the reimbursement amount is not capped. This reporter learned from the Municipal Human Resources and Social Security Bureau yesterday.

The insured does not pay extra fees.

According to the relevant person in charge of the Medical Insurance Department of the Municipal Human Resources and Social Security Bureau, the insured groups of urban residents' medical insurance in this city include elderly residents, low-income recipients, disabled people, minors and college students. Before the implementation of this policy, the maximum payment limit of medical insurance for urban residents in this city was 200,000 yuan. Some insured persons with serious diseases can only bear the medical expenses above the limit, which leads to poverty and return to poverty due to illness. In order to further improve the medical insurance system for urban residents and reduce the burden of medical expenses for serious illness of insured persons, our city has launched the Implementation Measures for Serious Illness Insurance for Urban Residents.

Serious illness insurance for urban residents refers to an insurance system that buys serious illness insurance from commercial insurance institutions on the basis of basic medical insurance for urban residents to further protect the high medical expenses incurred by seriously ill patients who participate in medical insurance for urban residents. It is a useful supplement to basic medical insurance. The serious illness insurance fund for urban residents is raised from the balance of the basic medical insurance fund for urban residents, and the insured individuals will not pay separately. By the end of last year, the number of people participating in medical insurance for urban residents in Dalian had reached 1 167000.

Critical illness insurance should settle accounts immediately.

The reporter learned that the insured's medical expenses for serious illness in the city's overall planning area will be settled immediately. In other words, insured persons who meet the reimbursement conditions can immediately enjoy the treatment of serious illness insurance.

According to the introduction of the Municipal Bureau of Human Resources and Social Security, on February 25 this year, the tender was started to select commercial insurance institutions. Commercial insurance institutions are selected by the municipal human resources and social security department through public bidding in accordance with the prescribed bidding procedures by using the unified bidding platform of the government. It is expected that the reimbursement of serious illness insurance for urban residents will be officially launched in mid-March.

The medical expenses incurred by the insured in non-designated medical institutions due to emergency and first-aid hospitalization that meet the requirements of basic medical insurance shall be paid in advance by individuals in cash when the medical expenses exceed the Qifubiaozhun for serious illness insurance. After medical treatment, related medical expenses shall be reimbursed by commercial insurance institutions according to the provisions of basic medical insurance on the basis of hospitalization records, hospitalization expenses details, hospitalization receipts, social security cards or medical insurance ic cards and other related materials.

It is estimated that after the implementation of serious illness insurance, the proportion of reimbursement for medical expenses of insured patients who meet the conditions of serious illness insurance will be greatly increased, including: more than 70% in tertiary hospitals and more than 80% in secondary and specialized hospitals.

Segmentation standard

There is no capping line for reimbursement amount.

In a natural year, the medical expenses incurred by urban residents' medical insurance participants in basic medical insurance coverage due to single or multiple hospitalizations, after the payment of basic medical insurance, the personal burden exceeds 16500 yuan, which is paid by the serious illness insurance according to the following standards: 50% of the personal burden is less than 50,000 yuan (including 50,000 yuan); 55% of the medical expenses borne by individuals ranging from 50,000 yuan to 654.38+10,000 yuan (including 654.38+10,000 yuan); Medical expenses borne by individuals are more than 60% and 65438+ less than 10,000 yuan150,000 yuan (including150,000 yuan); The medical expenses borne by individuals are 65% 654.38+0.5 million yuan but less than 200,000 yuan (including 200,000 yuan); 70% of the medical expenses borne by individuals are more than 200,000 yuan. The payment amount is settled progressively, and there is no capping line. This policy will further improve the level of medical security for serious illness and solve the problems of poverty caused by illness and returning to poverty due to illness.

In addition, minor residents and college students who participated in the basic medical insurance for urban residents died unexpectedly due to illness or non-third party liability, and the serious illness insurance paid a one-time pension of 50,000 yuan to the legal beneficiary. This is Dalian's unique policy of benefiting the people.