"Two diseases" medication protection: insured hypertension, diabetes residents in primary health care institutions, "two diseases" drugs within the scope of the policy does not set the starting line, reimbursement within the limit of 70%, the annual maximum reimbursement of hypertension 360 yuan, The maximum annual reimbursement is 360 yuan for hypertension and 600 yuan for diabetes, and the maximum reimbursement is 1,800 yuan for those who meet the admission standards for outpatient coverage of chronic special diseases.
Hospitalization security: insured residents in the designated medical institutions within the policy scope of hospitalization medical expenses, the starting line township health centers not less than 200 yuan, county hospitals not less than 500 yuan, municipal hospitals not less than 1,000 yuan, provincial hospitals in accordance with the previous year's hospitalization of about 10% of the average cost of hospitalization to determine (1500 yuan - 2300 yuan). The reimbursement ratio is no less than 80% for township health centers, 70% for county hospitals, 60% for municipal hospitals, and 50% for provincial hospitals (in three grades of 50%, 55%, and 60%). Hospitalization reimbursement annual maximum limit of 15 million yuan. major medical insurance: the insured residents within the policy scope of the cumulative out-of-pocket hospitalization costs over the starting line of major medical insurance part of the implementation of segmented compensation, the starting line of the previous year's per capita disposable income of about 50% of the residents to determine; after deducting the starting line of major medical insurance, 0 to 30,000 yuan (including) part of the reimbursement of 60%, 30,000 yuan more than 80,000 yuan (including) part of the reimbursement of 65%, 80,000 yuan more than 150,000 yuan (including) Partial reimbursement of 75%, partial reimbursement of 85% for more than 150,000 yuan; annual limit of 400,000 yuan. The starting line for the needy is reduced by 50%, the reimbursement rate is increased by 5%, and there is no ceiling line. Medical assistance: According to the "Hunan Provincial Medical Assistance Measures", the medical assistance object is divided into three categories, according to the category to enjoy the insurance subsidies, outpatient assistance, hospitalization assistance. Outpatient medical assistance annual limit of not more than 8,000 yuan, a type of assistance objects do not set a starting line, the proportion of assistance 90%, the second type of assistance objects starting line of 1,000 yuan, the proportion of assistance 50%; outpatient assistance for serious illnesses in accordance with the hospitalization standards, the annual limit and inpatient assistance **** with. Hospitalization medical aid annual limit of not more than 100,000 yuan, a class of aid objects do not set a starting line, the aid ratio of 90%, two, three types of aid objects starting line for the previous year's per capita disposable income of residents of 5%, 25%, the aid ratio of 70%, 50% respectively. After the medical aid subsidies still have the risk of returning to poverty and poverty relief object, you can apply for re-assistance, the specific standards of assistance by the cities and states in accordance with the region's medical assistance funds and financial support capacity reasonably determined. About the scope of medical insurance reimbursement Drugs:The varieties of the national health insurance drug catalog continue to increase every year, and the scope of protection continues to expand.The 2021 version of the drug catalog*** includes 2860 drugs, an increase of 151 over 2019, and most of the increase in varieties are negotiated drugs during the period of the national agreement, and the price of the drugs has been reduced significantly. On the basis of the national drug catalog, 716 preparations produced by medical institutions in the province will be included in the health insurance reimbursement; 551 types of traditional Chinese medicine tablets will be included in the health insurance reimbursement, further expanding the scope of medication protection for the insured. Consumables: 40,600 types of medical consumables (corresponding to the 20-digit national medical insurance code) are included in the scope of reimbursement under the medical insurance, which can meet the basic medical needs of patients treated in various clinical departments. Medical service items: according to the principles of clinical necessity, safety and effectiveness, and price appropriateness, 3225 medical service price items are included in the reimbursement of medical insurance, of which 2630 items (81.5%) are in Category A and 595 items (18.5%) in Category B. The medical service items are also included in the reimbursement of medical insurance for patients who need medical treatment in various clinical departments. The process of reimbursement for intra-provincial and inter-provincial medical treatment is more or less the same, and it is necessary to follow the steps of "filing, selecting a point, and holding a code/card for medical treatment". The filing and selection of points can be done online (National Medical Insurance Service Platform APP, Xiang Medical Insurance public number, small program, APP), through the window, telephone and other ways. If you fail to settle the bill directly for any reason, you can also go back to your place of participation to make manual reimbursement with the original invoice, the original cost list, a copy of your bank account, and a copy of your participant's ID card or social security card, according to the regulations of your place of participation. About the verification of health insurance identity Residents can verify their identity through ID cards, social security cards, and health insurance electronic vouchers after enrollment. Of the three identity media, the health insurance e-voucher is the most convenient, the resident health insurance participant through the national health insurance service platform APP or Xiang medical insurance public number, small program, APP and other ways to activate, through the cell phone show code can meet the relevant health insurance business needs. Since the residents' health insurance does not have personal accounts, the residents' health insurance does not issue physical health insurance cards. The physical card of the employee health insurance participant is actually a personal account bank card. About the time of enrollment and payment 2023 year residents of the medical insurance centralized enrollment and payment period in principle for the September 1, 2022 to December 31st. Coordination areas that do not meet the required participation rate as scheduled may extend the period of centralized participation and payment of contributions to February 28, 2023 as appropriate. Regarding the mode of participation In order to ensure the fairness and universality of basic medical insurance, and to curb speculative participation and selective participation, according to the provisions of the Law of the People's Republic of China on Basic Medical Care, Health Care and Health Promotion, which stipulates that "Citizens have the right and obligation to participate in basic medical insurance in accordance with the law", and the national requirement of universal participation, the mode of payment is in accordance with the principle of territorial management, and the urban and rural areas are subject to the principle of territorial management. In accordance with the principle of territorial management, urban and rural residents (including primary and secondary school students and pre-school children) participate in the insurance program on a household basis in their place of household registration or permanent residence. In school college and university students (including newborns) to school as a unit in the school location of the whole insurance, the school on behalf of the residents of the medical insurance premiums, unified registration procedures for the insurance. About the payment route According to the unified national deployment, the collection of health insurance premiums is the responsibility of the tax department. We advocate the Xiangtax social security APP, WeChat app, mobile banking and other "non-contact" payment methods; at the same time, we also take into account the needs of the public, retaining the manual counter, the village (community) staff on behalf of the collection of payment and other channels.