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Beginning in 2016, many provinces and cities in my country began to integrate urban medical insurance and rural medical insurance, merging the two into urban and rural residents’ medical insurance. The Education Network ZKJZxl170 International Paper Finance Network () compiled the "2016 Anhui Province Resident Medical Insurance Financial Subsidy Increase and Medical Insurance Reimbursement Proportion Standards". Welcome to read! Some information follows the policies of previous years. For the latest news, please check the official website. Thank you!
Reimbursement scope of rural medical insurance in Anhui Province
1. Outpatient compensation:
(1) Village clinics and village central clinics are reimbursed 60% of the time, with a limit of 10 yuan for prescription drugs per visit, and a limit of 50 yuan for prescription drugs for temporary rehydration by doctors at the health center.
(2) The town health center reimburses 40% of the fees for each visit, with a limit of 50 yuan for examination fees and surgical fees, and a limit of 100 yuan for prescription drugs.
(3) 30% reimbursement for visits to secondary hospitals, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.
(4) 20% reimbursement for visits to tertiary hospitals, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.
(5) There is a limit of 1 yuan per prescription attached to the traditional Chinese medicine invoice.
(6) The annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.
2. Hospitalization compensation
(1) Scope of reimbursement:
A. Medication expenses: auxiliary examinations: electrocardiogram, X-ray, film, The fee for laboratory tests, physical therapy, acupuncture, CT, MRI and other examinations is limited to 200 yuan; the operation fee (referring to national standards, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).
B. For elderly people over 60 years old who are hospitalized in Xingta Town Health Center, treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.
(2) Reimbursement ratio: Town health center reimburses 60%; second-level hospitals reimburse 40%; third-level hospitals reimburse 30%.
3. Compensation for serious illness
(1) Town risk fund compensation: All inpatients participating in rural cooperative medical insurance whose one-time or annual cumulative medical expenses are more than 5,000 yuan will be compensated. Segment compensation, that is, 65% compensation for 5,001-10,000 yuan, and 70% compensation for 10,001-18,000 yuan.
(2) The annual limit of compensation for town-level cooperative medical inpatient and uremia outpatient hemodialysis, cancer outpatient radiotherapy and chemotherapy is 11,000 yuan.
Q&A on Rural Medical Insurance in Anhui Province
Q: My parents now live in rural Anhui and have participated in the new rural medical insurance. Is there any cap on the reimbursement amount of this insurance? What is the maximum reimbursement amount? How much should I reimburse? In addition, I now want to buy another critical illness medical insurance for them. Will there be any conflict in the reimbursement of this insurance in the future?
If I see a doctor in a hospital in this province, can the reimbursement ratio be changed? reaches 50%. In addition, there is only one medical bill. If you apply for rural medical insurance, is there any way to go to the insurance company to apply for critical illness medical insurance?
Answer: The maximum cap of the new rural cooperative medical insurance is 40,000 yuan. Every year, the reimbursement ratio is up to 80% for town-level hospitals after the deductible, followed by 60% at county level and 45% at city level, and does not conflict with other commercial insurances. Please keep copies of all documents and ask the NCMS office that received your documents to stamp their official seal for reimbursement from commercial insurance.
Warm Tips for Rural Medical Insurance in Anhui Province
Compared with the launch of the system in 2007, the new version of the "Anhui Province Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog" released in 2010 There are 2,422 types of Class A and Class B drugs, which is an increase of more than 300 drugs compared with the previous version of the "Drug Catalog". At the same time, the scope of payment of medical insurance funds has gradually expanded, and the scope of prescribed outpatient diseases for serious diseases and chronic diseases has continued to increase.
In addition, our province focuses on solving the transfer and continuation of rural medical insurance relationships in Anhui Province that move between urban and rural areas by providing good medical insurance relationship transfer and continuation and off-site medical settlement services, thereby realizing the transfer and continuation of medical insurance relationships in different systems and different situations. Smooth transfer between regions. By coordinating medical insurance management and handling services with the "Yangtze River Delta" region, we will continue to improve the settlement methods for medical treatment in other places, so that insured persons in our province can better enjoy medical insurance benefits in other places.
In 2016, Hefei City continued to implement the basic medical insurance system for urban residents, a livelihood project, and increased the reimbursement benefits of medical insurance.
In order to help the majority of insured residents further understand the residents’ medical insurance policy, master how to participate in insurance, seek medical treatment, reimbursement and other related procedures, so as to better enjoy the government’s policies to benefit the people, the Hefei Municipal Human Resources and Social Security Bureau recently announced the residents’ medical insurance 2016-2016 Annual benefits and reimbursement policies.
Benefits of the insured persons
After the insured persons participate in the insurance and pay the premium, from October 1st of this year to September 30th of the following year, the insured persons will be entitled to the benefits with their medical insurance card, social security card, and identity card. (Those insured under the age of 18 can present their household registration book, hereafter referred to as: valid certificate), and can enjoy the following benefits:
① Hospitalization reimbursement benefits ② Special disease outpatient benefits ③ General outpatient benefits ④ Fertility expense subsidies ⑤ Subsidy benefits for disabled people to install assistive devices
●1. Hospitalization reimbursement benefits
Hospitalization in first-level hospitals:
Expenses within the scope of medical insurance exceed 200 yuan (minimum payment Standard) 90% of the above portion will be reimbursed;
Level 2 hospital hospitalization:
80% of the above portion if the expenses within the scope of medical insurance exceed 400 yuan (minimum payment standard);
< p>Hospitalization in a tertiary hospital:70% of the expenses within the scope of medical insurance exceeding 600 yuan (minimum payment standard) will be reimbursed;
Hospitalization in a different place (transfer and emergency department in another place):
p>50% of the expenses within the scope of medical insurance exceeding 600 yuan (minimum payment standard) will be reimbursed.
The hospitalization minimum payment standard and fund payment ratio are detailed in the table below:
The minimum payment standard for ordinary residents in medical institutions (threshold fee) is the minimum payment standard for school students, children and residents under the age of 18. Standard fund payment ratio (reimbursement ratio)
Tertiary hospitals 60030070%
Second-level hospitals 40020080%
First-level hospitals 20010090%
Out-of-town medical treatment 60030050%
1. Within one settlement year, the maximum cumulative fund payment limit for insured residents’ hospitalization, outpatient special disease and general outpatient services is 160,000 yuan.
2. To use Class B drugs and diagnosis and treatment items, individuals need to pay a certain amount first.
●2. Outpatient benefits for special diseases
Insured persons suffering from coronary heart disease, stage III hypertension, diabetes, mental illness, liver cirrhosis, malignant tumors, renal dialysis, and renal transplantation Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, aplastic anemia, hemophilia, breast cancer (endocrine therapy), hepatolenticular degeneration, chronic heart failure, chronic renal insufficiency, hyperthyroidism , epilepsy, hepatitis C, prostate cancer (endocrine therapy), bladder tumors (infusion therapy), liver transplantation, hematopoietic stem cell transplantation, rehabilitation treatment, chronic hepatitis B (antiviral treatment), pediatric cerebral palsy, etc. 27 Depending on the disease type, once the application is confirmed, 60% to 80% of the monthly limit will be reimbursed.
●3. General outpatient benefits
For insured residents’ medical expenses within the scope of the policy incurred in the outpatient clinics of community health service centers, the overall fund will pay 50% (incurred in other residents’ designated hospitals) General outpatient clinics do not enjoy this treatment). The maximum reimbursement limit for a single medical treatment is 40 yuan. The maximum reimbursement limit in a year is 160 yuan, of which: the maximum reimbursement limit for insured residents who are men over 60 years old and women over 55 years old is 240 yuan. There are no restrictions on disease types for reimbursement of general outpatient services, and medical expenses are settled directly at community health service centers.
●4. Subsidy for maternity expenses
For insured residents who comply with the family planning policy, a subsidy of 600 yuan for normal delivery (including assisted delivery) and 1,200 yuan for cesarean section will be provided.
●5. Subsidy benefits for insured disabled people to install assistive devices
Among the insured residents, lower-limb disabled people and hearing-impaired children under the age of 7 who hold a disability certificate are disabled in our city Subsidies will be given to people who are equipped with assistive devices at fixed-point institutions to assemble lower limb prostheses and equip them with hearing aids. Every five years, a subsidy of 2,000 yuan is provided for ordinary thigh prostheses fitted to certified lower limb disabled persons, a subsidy of 1,000 yuan for each calf prosthesis, and a subsidy of 2,400 yuan for hearing aids for hearing-impaired children under 7 years old. (Consultation hotline: 63536433)
Instructions for reimbursement processing
●1. Local hospitalization
Insured persons should seek medical treatment at designated medical institutions and hold valid certificates at The hospital handles medical insurance hospitalization procedures, and the medical expenses incurred are directly reimbursed and settled at the hospital when you are discharged.
If you do not seek medical treatment in a designated hospital or do not go through the medical insurance hospitalization procedures at the hospital, the medical expenses incurred will not be reimbursed.
●2. Application for special disease outpatient benefits
Insured persons must fill out the "Hefei Urban Resident Basic Medical Insurance Special Disease Outpatient Application Form" (available in the "Download Center" Download), and submit relevant medical records and medical examination reports from recent periods to the Special Disease Identification Office of the Hefei Medical Insurance Center. The Hefei Medical Insurance Center will organize medical insurance experts to conduct an appraisal. Those who meet the conditions will be issued an "Outpatient Special Disease Treatment Card" with the card. Enjoy special disease outpatient treatment. Appraisals are organized every three months. (Application address: No. 360, Jinzhai Road, City, third floor of the former Hefei Labor and Social Security Bureau, Tel: 62613036)
●3. Procedures for medical treatment in other places
Insured persons If the disease is difficult to diagnose or there is no treatment method in the city's tertiary hospitals (including specialized hospitals), you can apply to be transferred to another place for inpatient treatment. Transfers to other places must fill out the "Application Form for Transfer to Other Places", and after the opinions are signed by the designated hospitals above the third level in our city, they must be reported to the city's medical insurance agency for review and filing before being transferred to other places for treatment.
If an insured person suddenly becomes ill in another place and really needs hospitalization, he should be hospitalized in a local designated medical institution and report to the Municipal Medical Insurance Center by phone within 3 days after admission. (Registration phone number: 63536433)
Transfer and off-site emergency medical expenses will be paid by the individual first. Within one month after discharge, bring the transfer approval form, detailed list of hospitalization expenses, invoices, discharge summary and valid certificates to the Municipal Medical Insurance Center for reimbursement and settlement. (Address: 3rd Floor, Hefei Social Security Service Center, No. 88 Zhengwu Ring Road, Tel: 63536433)
●4. Application for maternity expense subsidies
Within one month after the childbirth is discharged from the hospital, Apply to the Municipal Medical Insurance Management Center with valid documents, birth certificate, birth certificate, medical invoice, detailed list of expenses and discharge summary. (Address: 3rd Floor, Hefei Social Security Service Center, No. 88 Zhengwu Ring Road, Tel: 63536318)
●5. Reimbursement for newborns with congenital diseases
Newborns with congenital diseases For congenital diseases such as sexual heart disease, if the neonatal insurance registration procedures are completed within three months from the date of birth, the newborn will enjoy the residents' medical insurance benefits from the date of birth. Hospitalization medical expenses due to congenital diseases should be reported to the Municipal Medical Insurance Management Center within 30 days after discharge with valid certificates, hospitalization invoices, detailed expense lists and discharge summaries. (Address: 3rd Floor, Hefei Social Security Service Center, No. 88 Zhengwu Ring Road, Zhengwu District, Tel: 63536318)
Critical illness medical insurance benefits
Insured persons who are hospitalized due to illness For medical expenses that exceed the deductible line by more than 20,000 yuan within the scope of the policy, the individual can enjoy critical illness insurance benefits and be reimbursed at a rate of 50%-80%. The specific segmentation ratio is:
The segmentation reimbursement ratio for personal out-of-pocket payments of more than 20,000 yuan within the scope of the policy
0 to 50,000 yuan (inclusive) 50%
50,000 yuan to 100,000 yuan (inclusive) 60%
100,000 yuan to 300,000 yuan (inclusive) 70%
300,000 yuan (inclusive) and above 80%< /p>
Specific reimbursement outlets, addresses and telephone numbers:
Yaohai District: China Life counter on Changjiang East Road, Hefei, address: No. 1005, Changjiang East Road, Tel: 64695751;
Luyang District: China Life Insurance counter on Shouchun Road, Hefei City, address: No. 90 Shouchun Road, Tel: 62637378;
Shushan District: China Life Insurance counter on Jinzhai Road, Hefei City, address: Financial Building, No. 384 Jinzhai Road, Tel: 62646571;
Baohe District: China Life Insurance Co., Ltd., Xindu Metropolis, Hefei City, Address: 22nd Floor, Metropolis, No. 1000, Ma'anshan Road, Tel: 62687364.
The city’s unified consultation hotline: 12333
Hefei Medical Insurance Center Resident Medical Insurance Office: 6353631863536208
Anhui Province’s urban residents’ medical insurance subsidies will be increased, and Anhui Province will invest this year 82.55 billion yuan was used to implement 33 people's livelihood projects, including 6 new projects.
This year, Anhui Province continued to implement 33 people's livelihood projects, with a total investment of 82.55 billion yuan.
According to the "Notice on the Implementation of 33 Livelihood Projects in 2016" (hereinafter referred to as the "Notice") recently issued by the provincial government, Anhui Province's livelihood projects will add 6 new projects this year, including the renovation of old urban communities.
Among them, Anhui Province will add rural road smoothing projects, nursing subsidies for severely disabled people, legal aid for urban and rural needy groups, improve rural grassroots party building and service funding guarantees, agricultural product food safety projects, and renovation of old urban communities. Waiting for 6 projects.
This year, Anhui Province will improve the implementation standards of 6 people's livelihood projects, 21 people's livelihood projects will continue to be implemented, and 6 projects that have completed their tasks or are in normal operation will withdraw from the category of people's livelihood projects.
The "Notice" requires that all levels and localities should adjust and optimize the structure of fiscal expenditures, vigorously reduce general expenditures, continuously strengthen the management of people's livelihood fund guarantees, and increase targeted assistance to specific groups of people with special difficulties.
This year, the whole society will learn about the implementation of people's livelihood projects through more channels. According to the requirements of the "Notice", Anhui Province will accelerate the coordinated application of big data, new media, and Internet platforms for basic information in the field of people's livelihood to promote people's livelihood. The work should be open, fair and impartial, and the level of scientific and information-based organization and implementation of people's livelihood projects should be improved.
In addition, we will also explore the establishment of a long-term management mechanism to support various market entities to increase the supply of people's livelihood security services and products through the purchase of services, equity cooperation, etc.
List of changed projects for people’s livelihood projects
Added 6 new projects for people’s livelihood
Rural road smoothing project. We will implement the project of smoothing county-level roads, smoothing township-level roads, widening and reconstructing old village-level roads, hardening roads in merged and merged villages, and hardening roads in larger natural villages in poor villages to effectively improve traffic conditions in rural areas.
Care subsidies for severely disabled people. Severely disabled persons who are assessed as Level 1 or Level 2 and require long-term care are provided with nursing subsidies to subsidize the additional long-term care expenses incurred by the disabled due to their disability.
Legal aid for disadvantaged groups in urban and rural areas. Provide legal aid to needy groups in urban and rural areas across the province who meet the conditions for legal aid, and promote the development of legal aid.
Enhance rural grassroots party building and service funding guarantees. We will improve a stable funding guarantee system that focuses on financial investment, and continuously improve rural grassroots party building and service guarantee capabilities.
Agricultural products and food safety engineering. Establish a rapid testing system for agricultural product and food safety in towns and communities, carry out agricultural product quality and safety certification, and promote the solution of agricultural product and food safety issues.
Renovation of old urban communities. Carry out reinforcement and renovation of old and dangerous buildings, and improve supporting facilities and environment in old urban residential areas to effectively improve the people's living and living environment.
Increase standards for six livelihood projects
Increase policy-based agricultural insurance subsidy standards. The premium financial subsidy standards for rice, corn, wheat, and cotton were increased from 15.84 yuan, 12 yuan, 9.72 yuan, and 16.32 yuan per mu in 2016 to 19.49 yuan, 13.54 yuan, 13.21 yuan, and 18.91 yuan respectively.
Increase the participation subsidy standards for the new rural cooperative medical care. The financial subsidy standard for the new rural cooperative medical system will be increased from 380 yuan per person in 2016 to 420 yuan.
Increase the subsidy standards for basic medical insurance for urban residents. The financial subsidy standard for urban residents' medical insurance will be increased from 380 yuan per person in 2016 to 420 yuan.
Raise the financing standards for critical illness insurance for urban and rural residents. According to Anhui Province’s implementation opinions on consolidating and improving the critical illness insurance system for urban and rural residents, the per capita financing standard for the New Rural Cooperative Medical Care Critical Illness Insurance has been raised from 15 yuan to 30 yuan in 2016, while the per capita financing standard for urban residents’ critical illness insurance remains at 30 yuan.
Increase subsidy standards for basic public health services. According to Anhui Province’s pilot plan for deepening the comprehensive reform of the medical and health system, the basic public health service subsidy standard was increased from 40 yuan per person in 2016 to 45 yuan.
Increase the standard of compulsory education funding guarantee subsidy. Promote urban and rural coordination, and increase the tuition and miscellaneous fees and public fund subsidy standards for urban compulsory education schools from 264 yuan per student in primary schools and 375 yuan per student in junior high schools in 2016 to 625 yuan and 825 yuan respectively (both including heating costs of 25 yuan). The per-student public funding subsidy standard for special education schools in the compulsory education stage will be increased from 5,000 yuan per student in 2016 to 6,000 yuan.