In May, 20 18, the General Office of Hubei Provincial Government issued the Notice on Improving the Relevant Policies of Basic Medical Security for Rural Poor People, which indicated that it would ensure that the actual reimbursement rate of hospitalization medical expenses for rural poor people would be increased to about 90%, the actual reimbursement rate of outpatient medical expenses for serious diseases and special chronic diseases would be increased to about 80%, and the annual actual medical expenses borne by individuals would be controlled within 5,000 yuan.
Among them, regarding the basic medical insurance policy for urban and rural residents, the individual contributions required by the rural poor to participate in the basic medical insurance for urban and rural residents are subsidized by the finance at the same level, and the specific subsidy standards are determined by the municipal (state) people's government according to relevant policies and regulations to ensure that they are all included in the scope of protection. The qifubiaozhun for the rural poor to be hospitalized in the first-level medical institutions within the county is not higher than 100 yuan, and the qifubiaozhun for hospitalization in the second-and third-level medical institutions within the county is uniformly determined by the municipal (state) people's governments. If the rural poor are hospitalized in this county, the reimbursement rate in the basic medical insurance (excluding serious illness insurance) policy shall be no less than 90% in the first-level medical institutions, 80% in the second-level medical institutions and 70% in the third-level medical institutions.
In terms of serious illness insurance for urban and rural residents, the minimum threshold for serious illness insurance is lowered, and the minimum threshold for serious illness insurance for rural poor people is reduced to 5,000 yuan; In an insurance year, the poor people in rural areas are hospitalized many times, and only one minimum payment for serious illness insurance is deducted. At the same time, increase the proportion of reimbursement for major illness insurance. If the accumulated personal burden is in line with the coverage of serious illness insurance, 60% of the part above the deductible to 30,000 yuan (inclusive), 70% of the part above 30,000 yuan to 654.38+10,000 yuan (inclusive), and 80% of the part above 654.38+10,000 yuan. Increase the maximum payment limit of serious illness insurance. The annual maximum payment limit of serious illness insurance for the rural poor is not less than 350 thousand yuan.
Original content of the attached notice:
Notice of the General Office of the Provincial People's Government on Improving the Relevant Policies of Basic Medical Security for Rural Poor People
Municipal, state and county people's governments and provincial government departments:
In order to ensure the basic medical care of the rural poor (hereinafter referred to as "rural poor") and promote the work of health and poverty alleviation, the "four in one" working mechanism of basic medical insurance, serious illness insurance, medical assistance and supplementary medical insurance is implemented in accordance with the principle of doing one's best and according to one's ability, so as to ensure that the actual reimbursement rate of hospitalization medical expenses for the rural poor is increased to about 90%, and the actual reimbursement rate of medical expenses for serious illness and special chronic diseases is increased to 80%. The relevant policies are hereby notified as follows.
I basic medical insurance policy for urban and rural residents
1. Subsidize personal insurance expenses. The individual contributions required by the rural poor to participate in the basic medical insurance for urban and rural residents are subsidized by the finance at the same level, and the specific subsidy standards are determined by the people's governments of cities (prefectures) according to relevant policies and regulations, so as to ensure that they are all included in the scope of protection.
2. Adjust the hospitalization Qifubiaozhun. The qifubiaozhun for the rural poor to be hospitalized in the first-level medical institutions within the county is not higher than 100 yuan, and the qifubiaozhun for hospitalization in the second-and third-level medical institutions within the county is uniformly determined by the municipal (state) people's governments.
3. Increase the reimbursement rate within the scope of the policy. If the rural poor are hospitalized in this county, the reimbursement rate in the basic medical insurance (excluding serious illness insurance) policy shall be no less than 90% in the first-level medical institutions, 80% in the second-level medical institutions and 70% in the third-level medical institutions.
Two, about the serious illness insurance policy for urban and rural residents
4. Reduce the threshold of critical illness insurance. The minimum threshold for serious illness insurance for the rural poor is reduced to 5000 yuan. In an insurance year, the poor people in rural areas are hospitalized many times, and only one minimum payment for serious illness insurance is deducted.
5. Increase the reimbursement rate of major illness insurance. If the accumulated personal burden is in line with the coverage of serious illness insurance, 60% of the part above the deductible to 30,000 yuan (inclusive), 70% of the part above 30,000 yuan to 654.38+10,000 yuan (inclusive), and 80% of the part above 654.38+10,000 yuan.
6. Increase the maximum payment limit for major illness insurance. The annual maximum payment limit of serious illness insurance for the rural poor is not less than 350 thousand yuan.
Third, about the medical assistance policy.
7 overall use of social assistance funds, give full play to the role of medical assistance. Implement the main responsibility of the county (city, district) people's government for medical assistance, and define the scope and conditions of medical assistance based on the medical information of the rural poor. Increase the overall use of social assistance funds, in addition to rural subsistence allowances and five-guarantee precision poverty alleviation subsidies, open channels for social assistance funds at all levels for medical assistance, and subsidize the medical expenses that the recipients meet the requirements. Strengthen the connection between medical assistance for serious illness and serious illness insurance, and provide medical assistance for serious illness to the rural poor in accordance with relevant regulations. All localities carry out outpatient assistance according to the actual situation.
Fourth, on the policy of guaranteeing the bottom.
8. Establish a bottom-up security system. The people's governments of cities (states) and counties (cities, districts) shall, in principle, provide basic medical insurance, serious illness insurance and medical assistance for urban and rural residents first, and then provide supplementary medical insurance (or bottom-up security funds), and provide bottom-up security for the rural poor by purchasing supplementary medical insurance or setting up bottom-up security funds.
In the city (state) as a unit, in accordance with the principle of "supporting fixed income, balance of payments and comprehensive security", scientifically calculate and reasonably determine the annual financing standard (or comprehensive security fund) of supplementary medical insurance.
9 unified supplementary insurance institutions. Municipalities (prefectures) people's governments shall, in accordance with the principles of safety, economy, convenience and efficiency, determine their own supplementary medical insurance agencies, and in principle give priority to the major illness insurance underwriting institutions for urban and rural residents.
10. Control the medical expenses beyond the policy scope. The medical expenses of the rural poor beyond the scope of the policy shall be shared by the supplementary medical insurance (or the overall security fund), rural poor individuals and medical institutions.
Proportion of medical expenses outside hospitalization policy to total medical expenses of rural poor population. No more than 3% of the first-class medical institutions in the county, no more than 8% of the second-class and third-class medical institutions in the county, and no more than 10% of the third-class medical institutions outside the county. The medical expenses within the specified proportion borne by individuals shall be shared by rural poor individuals and supplementary medical insurance (or security fund), and the specific measures shall be formulated by the municipal (state) people's government; Medical expenses exceeding the prescribed proportion shall be borne by medical institutions in principle.
Verb (abbreviation of verb) related policies and regulations
1 1. Define the scope and time limit of protection. All rural poor people (including those who have been out of poverty, those who have not been out of poverty, and those who have newly increased poverty) identified by the poverty alleviation department since 20 14 will enjoy insurance subsidies and "four-in-one" medical security benefits until the end of 2020. Among them, for the newly-increased rural poor, the "four-in-one" medical security treatment will be implemented according to the time when they are identified as poor.
12. Insist on promoting diagnosis and treatment in the county. The rural poor enjoy the "four in one" medical security treatment in the county, and the medical expenses for medical treatment outside the county are reimbursed according to the current medical insurance policy for urban and rural residents.
The rural poor can get compensation for their out-of-pocket expenses when they go to medical institutions outside the county, but they can only be referred after going through relevant procedures. The specific compensation measures shall be formulated by the municipal (state) people's government.
13. The rural poor who participated in the medical insurance for employees, after enjoying the medical insurance benefits for employees according to the regulations, did not reach the treatment level of the rural poor, and the supplementary medical insurance (or the overall security fund) made up the treatment to ensure that their medical insurance treatment level reached the work goal.
14. If the poor people in rural areas suffer from accidental injuries (except the third party's liability) and give birth in hospital, they will be reimbursed by basic medical insurance, serious illness insurance and medical assistance in accordance with the current urban and rural residents' policy, and they will be compensated by supplementary medical insurance (or overall security fund) to ensure that their medical security treatment level reaches the work goal.
15. the current medical security policy for rural poor dependents, family members with minimum living security, orphans and poor disabled people will remain unchanged.
Six, about handling management services
16. Improve the accuracy of personnel identification. Poverty alleviation departments should clarify the criteria for identifying the rural poor, carry out data verification according to the standards, clarify the basic information of the rural poor in the national poverty alleviation and development information system, fill in the core data such as ID numbers, strengthen the comparison and convergence with the urban and rural residents' medical insurance information system, the residents' health file management system and the civil and social assistance information system, and do a good job in dynamic management of rural poor data. Every year before 10 (before the start of medical insurance collection for urban and rural residents), the information of rural poor people will be officially notified to the local tax authorities and social security agencies.
17. Implement the system of "pay after treatment". The poor people in rural areas are hospitalized in designated medical institutions in the county, and they shall go through the admission procedures with social security cards, valid identity documents and poverty certificates issued by poverty alleviation departments, and sign an agreement on payment after diagnosis and treatment. When you are admitted to the hospital, you only need to pay the basic medical insurance hospitalization Qifubiaozhun fee, and you don't need to pay the hospitalization deposit.
All localities should establish a fund pre-allocation system, speed up the examination, settlement and disbursement of funds, shorten the prepayment cycle of medical institutions, and reduce the prepayment pressure of medical institutions. The specific measures shall be formulated by the municipal (state) people's government.
18. Implement "one-stop" instant settlement. County (city, district) people's government to co-ordinate the "one-stop" instant settlement. Health and family planning, human society, civil affairs, poverty alleviation, insurance supervision and other departments should strengthen communication and cooperation, connect various medical security information systems, and build a "one-stop, one-vote system" information exchange and instant settlement platform in designated medical institutions within the county to ensure that rural poor people can handle and settle in one window when they leave the hospital.
Seven, about the responsibilities of the department
19. Implement departmental responsibilities and strengthen cooperation and coordination. Health and family planning departments should take health poverty alleviation as the leading factor, do a good job in health poverty alleviation, establish a supplementary medical security mechanism for rural poor people, control the unreasonable increase of medical expenses, and implement "first diagnosis and treatment, then payment" and "one-stop service, one-vote settlement". The human and social departments should take basic medical insurance as the leader and do a good job in medical insurance precision poverty alleviation. The agency shall, according to the receipt, complete the insurance registration procedures in time and enter them into the medical insurance information system for urban and rural residents, based on the data of rural poor population provided by the poverty alleviation department. The poverty alleviation department is responsible for strengthening the dynamic management of the rural poor, providing basic information on the dynamic changes of the rural poor in a timely manner, organizing and ensuring the full participation of the rural poor, supervising and implementing their individual payment subsidies, and strengthening the supervision and assessment of health poverty alleviation work. The civil affairs department is responsible for determining the poverty alleviation targets such as family members with minimum living allowance, destitute dependents and orphans, organizing and ensuring the poverty alleviation targets such as family members with minimum living allowance, destitute dependents and orphans to participate in the basic medical insurance for urban and rural residents, and implementing the individual payment policy of the insured; Do a good job in connecting medical assistance with basic medical insurance and serious illness insurance. The financial department should provide financial support for health and poverty alleviation through existing channels according to the needs of work and the division of powers, and urge all localities to implement various security funds. The local tax department is responsible for the collection of individual contributions to the basic medical insurance for urban and rural residents, and cooperates with relevant departments to ensure that the subsidy funds for the rural poor are paid into the state treasury in full and on time, so as to avoid repeated payment by the rural poor. Insurance regulatory authorities should strengthen the supervision and management of underwriting commercial insurance companies and urge them to realize immediate settlement. Other relevant departments should carry out their duties and do a good job in the basic medical security for the rural poor. ;