1, unify the proportion of medical insurance reimbursement. After the implementation of the new regulations, the proportion of medical insurance reimbursement is uniformly adjusted to 80%, and the coverage items mainly include hospitalization expenses, outpatient expenses and drug expenses;
2. Increase hospitalization reimbursement items. After the implementation of the new regulations, medical insurance institutions will increase the inspection and management fees for large-scale equipment of medical institutions in hospitalization reimbursement projects to better protect patients' medical rights and interests;
3. Increase the proportion of drug reimbursement. In order to better protect patients' rights and interests in drug use, the new regulations increase the reimbursement rate of drugs to 90%, and divide drugs into three categories (chronic drugs, routine drugs and anti-infective drugs), and set different reimbursement rates according to different types;
4. Strengthen the supervision of reimbursement. After the implementation of the new regulations, medical insurance institutions will strengthen the supervision of reimbursement items. Any reimbursement application that does not meet the medical insurance reimbursement standards will be reviewed in time, and those who are irresponsible will be held accountable.
Reimbursement scope:
1, medical expenses insurance liability in medical insurance coverage.
Part of the expenses still borne by individuals after reimbursement of basic medical insurance, serious illness insurance and medical assistance in the medical insurance catalogue. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,10.5 million free of compensation, the reimbursement rate is 80%, and the reimbursement rate for continuous participation is increased to 85%;
2, medical insurance liability outside the scope of hospitalization expenses.
The expenses outside the medical insurance catalogue are still borne by individuals after being reimbursed by basic medical insurance, serious illness insurance and medical assistance. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,1.8,000 free of compensation, the reimbursement rate is 60%, and the reimbursement rate for continuous participation is increased to 65%;
3, outpatient specific high drug cost insurance liability
The part of the drug expenses paid in designated hospitals and pharmacies, which is borne by individuals, shall be liable for compensation within the agreed scope of insurance liability. 700,000 insured amount, 26 kinds of drugs, and the insurance liability of the outpatient drugs/inpatient medical insurance expenses for rare diseases is * * * 20,000 yuan, and the compensation ratio is 80%;
4. Clearly stipulate the insurance liability of outpatient drugs/hospitalization medical insurance expenses for rare diseases.
The part of the drug expenses paid in designated hospitals and pharmacies, which is borne by individuals, shall be liable for compensation within the agreed scope of insurance liability. The insured amount is 300,000 yuan, 12 kinds of drugs, and the insurance liability of outpatient specific high drug expenses is 20,000 yuan, and the reimbursement ratio is 70%.
To sum up, basic medical insurance (including basic medical insurance for urban workers and basic medical insurance for urban and rural residents) is closely related to inclusive prices. Focus on ensuring the high medical expenses caused by major diseases and accidental injuries, and provide more adequate protection for major diseases. Compared with general commercial insurance, there are no restrictions on the age and occupation of the insured, and the health conditions are more tolerant. At the same time, the product also expanded the treatment cost of 20 kinds of high-priced specific drugs and 10 kinds of designated rare disease drugs outside the medical insurance catalogue.
Legal basis:
Article 2 of People's Republic of China (PRC) Insurance Law
The term "insurance" as mentioned in this Law refers to the commercial insurance behavior in which the applicant pays the insurance premium to the insurer according to the contract, and when the insured dies, suffers from disability, illness or reaches the age and time limit agreed in the contract, the insurer shall be liable for the property losses caused by the possible accidents agreed in the contract.
essay
This Law is applicable to insurance activities in People's Republic of China (PRC).
Article 5
The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of good faith.