Nantong social insurance big disease reimbursement ceiling

The pilot areas of major disease insurance in the insurance can appropriately increase the payment flexibility according to the actual situation. The actual payment ratio of major disease insurance is not less than 50%, and in principle, there is no maximum payment limit.

Learned from the Ministry of Human Resources and Social Security, social security in the major disease insurance will be the first pilot gradually rolled out, in principle, does not set a maximum payment limit.

Payment items are limited to health insurance

The Ministry of Social Affairs held a symposium on September 17th on major disease insurance in social security and total control of health insurance payments, and Hu Xiaoyi, vice minister of the Ministry of Social Affairs, introduced the urban and rural residents' major disease insurance as a way to improve the health care system and innovate the exploration of public **** services, which is a new thing. Localities will combine the actual, first pilot, stage evaluation, summarize the experience, and then gradually pushed out.

Hu Xiaoyi introduced that to carry out major disease insurance for urban and rural residents, localities can refer to the annual per capita disposable income of local urban residents or the annual per capita net income of rural residents to determine the starting standard for major disease insurance. The medicines and treatment items paid for by the major disease insurance in social security are, in principle, limited to the scope of the basic medical insurance policy. Pilot regions can appropriately increase the payment flexibility according to the actual situation. The actual payment ratio of the major disease insurance is not less than 50%, and in principle, there is no maximum payment limit.

Will be out of commercial institutions assessment methods

Hu Xiaoyi introduced, for social security in the introduction of major disease insurance commercial insurance institutions, will establish the level of protection and participant satisfaction as the core of the assessment methods, reasonable control of commercial insurance institutions profitability.

In the specific operation, the basic medical insurance and commercial insurance will be considered in an integrated manner, and will be articulated in various aspects such as enrollment, payment, fund transfer, fund financial management, payment and settlement, and cost review.

Hu Xiaoyi has emphasized that, despite the introduction of commercial insurance institutions, but the major medical insurance policy is still a public **** policy of the government, only relying on market resources, and asked commercial insurance companies to specific management, the source of its funding from the urban residents medical insurance, the new rural cooperative surplus funds allocated.

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