New 2017 health insurance policy 1: the basic realization of the national network of health insurance in 2017
The Ministry of Human Resources and Social Security on the afternoon of the 13th on the Chinese government won the International Social Security Association "Outstanding Achievement Award in Social Security" held a press briefing. With regard to the progress of direct settlement of hospitalization expenses, Huang Huabo, deputy director of the Social Insurance Business Management Center of the Ministry of Human Resources and Social Security, said on the 13th that the Ministry of Human Resources and Social Security and the Ministry of Finance have jointly issued a document, with the goal of basically realizing the nationwide network by the end of 2016 and launching the work of direct settlement of hospitalization medical expenses for retired personnel resettled in a different place across the provinces; and starting to gradually settle the direct settlement of hospitalization medical expenses for retired personnel resettled in a different place across the provinces from the beginning of 2017. direct settlement of hospitalization medical expenses for retirees, and expanding to direct settlement of hospitalization medical expenses for people who meet the referral requirements at the end of the year.
2017 new policy of medical insurance 2: the different places have made two major breakthroughs
In response to a reporter's question about it, the relevant person in charge said that in order to do a good job of direct settlement of hospitalization expenses for different places, the Ministry of Human Resources and Social Welfare set up a thematic working group, formulated the work program, a clear task, backward scheduling, focusing on tackling the problem, and is now making some major breakthroughs, the main Performance in two aspects:
On December 9, the Ministry of Human Resources and Social Security and the Ministry of Finance jointly issued the Notice on Doing a Good Job of Direct Settlement of Hospitalization Medical Expenses for Basic Medical Care Across Provinces and in Different Places. This is the Ministry of Human Resources and Social Affairs issued No. 120 of 2016. The document clarifies some major issues such as the goal and mission, basic principles, main policies, settlement mode, handling protocols, responsibilities of the ministerial and provincial platforms, and the construction of the information system.
Last week, the national cross-district medical settlement system passed preliminary acceptance. This marks the official shift of this work from policy decision-making and system construction to this stage of policy implementation and trial operation of system docking between ministries and provinces. Meanwhile, local scheduling in Beijing, Tianjin, Hebei, Shanghai and Guangdong has been strengthened, urging that this year, all localities must realize the inter-provincial cross-district medical insurance settlement and make preparations for docking with the ministerial system.
2017 new health insurance policy 3: the end of 2017 to realize the direct settlement of medical expenses of compliant personnel across different places
When exactly will the direct settlement of medical expenses across different places be realized, the Ministry of Human Resources and Social Security also gave an answer:
2016 basically realize the national network, which is a key word.
Starting the direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces is a key word here. The other is the retirees who are resettled across provinces, not all retirees.
The direct settlement of hospitalization medical expenses for retirees resettled across provinces began in 2017, not that it could be completed by the end of 2016, but that it was initiated at the end of 2016, and that it could be resolved by the direct settlement of medical expenses for retirees resettled across provinces in 2017.
2017 medical insurance new policy 4: 2017 residents medical insurance participation and payment policy
One is that the individual contribution standard will be moderately adjusted. With the increase in medical consumption level, the state has increased the financial subsidy funds for residents' health insurance year by year, and the individual contribution standard in 2017 will be appropriately increased. The contribution standard will be 60 yuan for students and children, 100 yuan for elderly residents aged 60 or older, and 300 yuan for other unemployed urban residents, an increase of 10 yuan, 30 yuan and 100 yuan respectively. Individuals with low income, disabilities, and the "three have-nots" are still not required to pay.
The second is the newborn's medical expenses to realize "retroactive" reimbursement. The new policy stipulates that newborns who have paid for resident medical insurance within 90 days (including 90 days) from the date of birth can have their medical expenses for hospitalization paid by the medical insurance fund in accordance with the regulations.
Third, the outpatient agreed institutions can not "unauthorized binding". From January 1, 2017 onwards, the insured residents only need to take the "medical card" to the selected outpatient agreed institutions to go through the agreed procedures during the first outpatient visit, you can enjoy the outpatient integrated treatment according to the provisions. There is no need to go through the appointment procedure in advance, and the outpatient appointment institutions are not allowed to carry out "unauthorized binding" operation against the will of the insured residents.
2017 medical insurance new policy 5: 2017 medical insurance reimbursement
A, 2017 major medical insurance reimbursement scope
1. malignant tumor treatment: including malignant tumor chemotherapy (including endocrine-specific anti-tumor therapy), malignant tumor radiation therapy, isotope anti-tumor therapy, interventional anti-tumor therapy, and traditional Chinese medicine anti-tumor therapy.
2. Outpatient hemodialysis and peritoneal dialysis for severe uremia.
3. Anti-rejection treatment after kidney transplantation.
4. Treatment of major psychiatric illnesses: schizophrenia, depression (moderate and severe), mania, obsessive-compulsive disorder, mental retardation with mental disorders, epilepsy with mental disorders, paranoid psychosis.
It should be noted that the following cases are not covered by the medical insurance for major diseases:
1. Unauthorized visits to non-scheduled hospitals (except for emergency rescue);
2. Occupational diseases, injuries sustained at work or recurrence of work-related injuries; injuries caused by traffic accidents;
3. Injuries caused by the violation of the law by the person himself or herself;
4. food poisoning caused by liability accidents;
5. treatment due to suicide (except for psychotic episodes);
6. injuries caused by medical malpractice;
7. according to the state and municipal regulations of the medical expenses should be self-care.
Two, the proportion of major medical insurance in 2017
1. Starting line: 20,000 yuan. More than 20,000 yuan, can be reimbursed through the major medical insurance.
2. Above the starting line, the proportion of reimbursement by the major medical insurance is:
1) 20,000 yuan - 50,000 yuan: the major medical insurance is reimbursed in accordance with 50%;
2) 50,000 yuan - 100,000 yuan: the major medical insurance is reimbursed in accordance with 60%;
3) more than 100,000 yuan: the major medical insurance is reimbursed in accordance with 70% reimbursement.
3. Annual reimbursement ceiling: 300,000 yuan.
Three, 2017 major medical insurance reimbursement process
1. major medical insurance reimbursement required materials
1) participant ID card;
2) participant medical insurance or medical card;
3) original and copy of the settlement list of medical expenses.
2. The process of reimbursement of major medical insurance
1) the participants need to bring the above materials to the local hospitals to fill out the relevant forms for the initial examination; 2) the hospitals will be the initial examination of the information of the insured residents reported to the municipal health insurance agencies for review;
3) the final examination of the insured residents by the municipal health insurance agencies to issue a major medical reimbursement The medical insurance reimbursement.
Four, 2017 major medical insurance reimbursement years
Maximum of two years from the date of the first diagnosis or recurrence of malignant tumors, of which malignant tumors herbal treatment can be enjoyed for five years.
Compared with previous years, what are the changes in the new policy of major medical insurance in 2017? The changes are mainly reflected in the following aspects: 1. Reduce the starting standard: the starting standard is reduced from 20,000 yuan to 18,000 yuan.
2. Increase the reimbursement rate: the payment rate for adult residents, children and teenagers, and college students participating in the first tier of contributions was increased from 60% to 65%; the payment rate for adult residents participating in the second tier of contributions was increased from 50% to 55%.
3. The over-limit subsidy is increased: 90% reimbursement for employee health insurance participants; 80% reimbursement for adult residents, children and teenagers and college students paying first-tier contributions, and 70% reimbursement for adult residents paying second-tier contributions.
4. The large amount of subsidies increased: 75% reimbursement for employee health insurance participants; 60% reimbursement for adult residents, children and teenagers, and college students in the first tier of contributions; and 50% reimbursement for adult residents in the second tier of contributions.
5. Free vaccination for children: the second dose of chickenpox vaccine is free for children who have reached the age of 4.
Questions and answers related to the new policy of health insurance in 2017
A. How to use the money in the account of the health insurance card
We all know that the employee health insurance is generally divided into an individual account and a co-ordinated account, and how to use these two respectively?
Individual account can pay the following expenses:
1. designated retail pharmacy drug costs, outpatient, emergency medical expenses;
2. used to buy their own commercial insurance, accidental injury insurance, etc.;
3. basic medical insurance co-ordination fund starting standard of the medical fees;
4. more than the basic medical insurance co-ordination fund starting standard, in accordance with the proportion of the individual to bear the costs of In the event that the individual account is insufficient to pay the portion of the medical fee, the individual shall pay the fee in accordance with the proportion of the medical fee payable by him/her.
5.
The fund mainly pays for the following expenses:
1. medical expenses for hospitalization;
2. outpatient medical expenses for radiation treatment of malignant tumors, renal dialysis, and anti-rejection medication after renal transplantation;
3. medical expenses for patients admitted to hospitalization after emergency rescue and hospitalization within seven days prior to hospitalization.
Two, the scope of reimbursement of medical insurance
1, the reimbursement of medical insurance card is limited to the designated hospitals due to disease and part of the accident caused by the hospitalization of more than the medical expenses.
The reimbursement formula is: (total cost - threshold fee - out-of-pocket expenses - overspending) * (75 + age * 0.2)%, under normal circumstances, the actual reimbursement rate ranges from 20 to 60%.
Out-of-pocket expenses are not reimbursed, 80% of Class B drugs are reimbursed, there is a limit on bed charges, and some examination and treatment fees are not reimbursed according to regulations.
2. The reimbursement amount of the health insurance card is 4 times of the local social wage (the cumulative value in 1 year).
3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and to pay for outpatient and emergency treatment, but it is not reimbursed because the money in the card is the money in the individual account of the medical insurance.
4. Reimbursement for major medical insurance
After a participant suffers from a major illness, the part of the individual's out-of-pocket expenses incurred in the city's medical insurance designated medical institutions and in accordance with the city's medical insurance regulations are included in the scope of the resident's major medical insurance, and are reimbursed by the funds of the major medical insurance for 50 percent of the expenses.
That is, the reimbursement amount = deductible × 50%
Three, medical card reimbursement ratio
Ministry of Human Resources and Social Security announced in July this year, "human resources and social security development" Thirteenth Five-Year Plan "Outline," China's employees and urban and rural residents in the basic medical insurance policy coverage of hospital expenses The proportion of payment will be stabilized at about 75%.
Four, the new use of medical insurance card
1, can be used as an ID card
October 1, 2015, the criminal law amendment (IX) will be social security card into the scope of documents that can be used to prove identity in accordance with the law. Where the act of forgery, alteration, sale and purchase of social security cards, according to the law to investigate their criminal liability; where the use of forged, altered or stolen social security cards of others, according to the law to investigate their criminal liability.
2, some provinces and cities can be used for fitness
The second half of this year, Shandong, Chongqing, Jiangsu Province, some provinces and cities, the employee himself can use the balance of the personal account, in the fitness center to carry out fitness activities. But may not be used to buy food, clothing, fitness equipment or cash sets.
Fifth, the use of health insurance cards need to pay attention to
1, prohibit cash
Any unit, individuals shall not violate the scope of use of health insurance cards and requirements, is strictly prohibited to cash.
2, part of the provincial and municipal health insurance card can be used by the whole family
Since the second half of this year, some provinces and municipalities, such as the province of Zhejiang, Guangzhou City, health insurance personal account balance funds over the years can be used to pay for the basic medical insurance for employees' spouses, children, parents and other close relatives of the medical insurance costs, to achieve the realization of family members of the ****ji mutual aid.
3, the following cases of medical insurance will not be paid
in the non-designated medical structure or non-designated retail pharmacy purchase of drugs (except for emergencies);
due to their own fights and assaults, drug abuse or other illegal behavior caused by their own injuries;
due to alcoholism, suicide, self-inflicted injuries and other reasons for medical treatment;
due to traffic accidents, medical malpractice or other responsible accidents causing injuries;
and cases that should be paid by the individual according to national or local regulations.
Sixth, how to check the balance of the medical insurance card
Participants can call 12333 social security consulting phone or through the Bank of China Savings, downtown designated hospitals, pharmacies and other ways to check the balance of the individual account of medical insurance.
Extended reading: insurance how to buy, which is good, hand to teach you to avoid the insurance of these "pits"