(a) the insured object
Urban and rural residents not covered by the basic medical insurance for urban workers in this area:
1. Urban and rural non-employed residents;
2. College students;
3 other personnel stipulated by the state and our province.
(2) Funding standards and regulations
1.2022 The individual financing standard for insurance expenses is 320 yuan/person/year.
2. Residents who need to participate in medical insurance for urban and rural residents after March 3, 2022, Kloc-0, can apply for sporadic insurance, and pay the insurance premium (900 yuan/person/year) according to the sum of the individual payment standard and government subsidies in that year, and begin to enjoy medical insurance benefits for urban and rural residents 60 days after the payment date.
3. Newborns can participate in medical insurance for urban and rural residents at their domicile or guardian's residence, and implement dynamic insurance. The guardian shall handle the insurance registration formalities for the baby within 90 days after birth, and pay the medical insurance premium for urban and rural residents according to the personal payment standard of the year, and enjoy the medical insurance benefits for urban and rural residents from the date of birth; If the payment is over 90 days, the urban and rural residents' medical insurance expenses will still be paid according to the personal payment standard of that year, and they will enjoy the medical insurance benefits for urban and rural residents after 60 days from the date of payment.
Second, the proportion of outpatient reimbursement
(1) General outpatient treatment: the outpatient medical expenses that meet the reimbursement scope in the designated medical institutions at the grass-roots level (level 1 and below) and at the designated medical institutions at the county level (level 2) in the overall planning area are included in the outpatient reimbursement, and there is no threshold. The specific reimbursement ratio is: township medical institutions (level 1 and below) 85%, county (level 2) medical institutions 50%. In an insurance year, the top line of general outpatient co-ordination cumulative reimbursement is 400 yuan/person.
(II) Outpatient treatment of chronic diseases: the annual deductible line for outpatient chronic diseases is 1.50 yuan, and the deductible line for outpatient chronic diseases does not participate in the accumulation of inpatient deductible lines. Suffering from multiple chronic diseases, only one deductible line is paid. For multiple chronic diseases, the fund payment limit can be superimposed, but the employee shall not exceed 1.7 million yuan per year, and the resident shall not exceed 1.0 million yuan per year. Employees' medical insurance chronic disease clinics are reimbursed according to the proportion of 90% (regardless of the level of medical institutions), and residents' medical insurance chronic disease clinics are reimbursed according to the proportion of hospitalization reimbursement of medical institutions at the same level in the overall planning area. Among them, the outpatient treatment of hypertension and diabetes is carried out according to the Implementation Opinions of the Provincial Medical Insurance Bureau, the Provincial Department of Finance, the Provincial Health and Health Commission and the Provincial US Food and Drug Administration on Improving the Outpatient Medication Guarantee Mechanism for Hypertension and Diabetes among Urban and Rural Residents (Qian Medical Insurance Fa [2019] No.54).
Glaucoma, pneumoconiosis (non-work-related injury), Alzheimer's disease, rheumatic heart disease, compensated cirrhosis, decompensated cirrhosis, hepatolenticular degeneration, HIV infection, chronic obstructive pulmonary disease, dilated cardiomyopathy, 1 diabetes, no stroke sequelae (cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage), and stroke sequelae (cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage). Peripheral neuropathy and retinopathy), essential hypertension (with heart, brain and kidney damage), coronary heart disease (with myocardial infarction, severe arrhythmia and cardiac enlargement), myasthenia gravis and Parkinson's disease.
(3) Outpatient special diseases
Special disease clinics have no annual deductible. At the same time, for all kinds of outpatient special diseases, the fund payment limit can be superimposed, and the superimposed annual payment limit shall not exceed the annual payment limit of the medical insurance fund (the sum of the basic medical and serious illness insurance payment limits). For diseases with a specific limit, the superimposed fund payment limit shall not exceed the actual combined calculation limit. Hemophilia, anti-rejection therapy after organ transplantation, systemic lupus erythematosus, aplastic anemia, myelodysplastic syndrome, multidrug-resistant pulmonary tuberculosis, immune thrombocytopenia, ankylosing spondylitis, rheumatoid arthritis, hemophagocytic syndrome, anti-fibrosis therapy of pulmonary interstitial diseases, radiotherapy and chemotherapy for benign tumors of nervous system.
Third, hospitalization compensation.
(A) basic medical insurance hospitalization benefits
The medical expenses incurred by the insured residents in the designated medical institutions that meet the scope of reimbursement shall be reimbursed in proportion. The reimbursement standards are as follows:
1. Coordinate hospitalization reimbursement standards of designated medical institutions in the region.