Medical assistance for major diseases of urban and rural poor people is generally applied in writing by the head of household during the treatment of patients. City residents to apply to the community, and provide relevant certification materials (must provide specific disease proof of designated medical institutions.
Rural five-guarantee households and poor households can directly apply to the township (town) civil affairs department and provide relevant certification materials. After the preliminary examination meets the requirements, fill in the application form, and report it to the county-level civil affairs department for examination and approval after being audited by the village Committee and reviewed by the township (subject to household investigation and verification).
The writing format of the application for serious illness relief in rural areas is actually not very complicated. First of all, patients need to know the name of the government where they are registered and their own cases.
Application description:
(1) At the beginning of the application, it is necessary to clearly write down the application place and describe the patient's situation in detail, such as the patient's name, gender, age, home address, etc. These addresses must be described in detail so that the government can further confirm the information and ensure that once the application is approved, the money can be accurately delivered to itself.
(2) The second step of applying for serious illness relief in rural areas is to state the reasons for your application, which need to describe your symptoms and family situation in detail, and the situation must be as true as possible. It is best to attach a copy of your case when applying, so that the examiner can easily understand your situation.
The focus of rural medical security in China will shift to serious illness. 20 diseases included in critical illness protection: childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, drug-resistant tuberculosis, AIDS opportunistic infection, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer and rectal cancer.
Extended data:
Medicaid for serious illness, full name of Medicaid for major illness. It refers to a medical subsidy system established by the insured on the basis of enjoying the basic medical insurance benefits to resolve the huge economic risks brought by serious illness treatment.
allowance
Annual payment limit
0-65438+ million yuan
65438+ more than 10,000 yuan-1.5 million yuan
brief introduction
There is no need to apply for Medicaid for major diseases; In each social security year, the insured person's hospitalization and outpatient treatment of specific projects exceed the basic medical expenses corresponding to the maximum payment limit of the overall fund, which is paid by the serious illness subsidy. The maximum payment limit of the serious illness subsidy in each social security year is 6.5438+0.5 million yuan.
Subsidy scope
Who can enjoy Medicaid?
Medicaid targets the following persons with local household registration: key entitled groups, namely disabled soldiers (excluding Grade 6 or above), survivors of martyrs, survivors of soldiers who died in the line of duty, survivors of deceased soldiers, veterans of the Red Army who returned to their hometowns, separated Red Army personnel, and demobilized soldiers who returned to their hometowns (1954 65438+ 10/).
And the revolutionary "five old" personnel, that is, the old underground party member, the old guerrillas, the old joint households, the old traffic policemen and the old Soviet cadres who participated in the revolution before the founding of the People's Republic of China and now enjoy regular living allowances after the examination by the people's governments at or above the county level.
Subsidy scope: the staff of state administrative organs and their retirees who meet the requirements of the Provisional Regulations on State Civil Servants and the Implementation Plan of State Civil Servant System; Referring to the party and mass organs, people's congress organs and CPPCC organs managed by the national civil service system,
Workers and retirees of democratic parties, organs of the Federation of Industry and Commerce, and other units that are managed with reference to the national civil service system;
Staff and retirees of public institutions managed with reference to the national civil service system; Staff of judicial organs and procuratorial organs and their retirees.
20 1316 Ministry of Health introduced that in 2013, the focus of rural medical insurance in China will shift to serious illness. 20 kinds of diseases such as lung cancer and gastric cancer are all included in the scope of serious illness protection, and the actual reimbursement rate of hospitalization expenses for seriously ill patients is not less than 70%, and the highest can reach 90%.
Different medical insurance systems
In the rich areas such as the eastern coastal rural areas and urban suburbs, where the productivity level and farmers' living standards are rapidly improving, the conditions for comprehensively promoting the construction of rural social security system are basically available. Measures should be taken to establish various systems and service networks of rural social security in an all-round way. The construction of medical security system should be combined with urban and rural development, and farmers' medical security system can be transferred to cities and towns or even merged.
In these developed areas, the rural labor force has been sharply divided, and there has been a large-scale phenomenon of non-agriculture and employment. Most farmers have stable jobs and residences, which is convenient for exploring the medical security system, so as to reach the goal of extending to the countryside and narrowing the gap between urban and rural areas.
These areas can imitate the methods of social insurance in cities and towns, or set up social insurance projects and formulate insurance measures on their own, actively pilot the farmers' medical insurance system combining social pooling with family account, develop personal health insurance, and establish and improve the national medical assistance system.
In the developed areas above the medium level, we can try to transition to the medical insurance system on the basis of developing and perfecting the current cooperative medical system. With the development of social economy and the deepening of work, the rural social security system will be fully established.
In view of the disadvantages of the current cooperative medical system, we should actively improve and innovate and gradually improve the degree of socialization. At the same time, create conditions to choose some rural medical insurance, and gradually expand the scope, so that the social insurance system covers the vast majority of residents.
In economically underdeveloped areas, at present, the key is to do a good job in poverty alleviation and social mutual assistance and special care, first solve the problem of food and clothing, and encourage farmers to establish cooperative medical insurance on a voluntary basis.
Increase reimbursement efforts
The reimbursement rate has increased by 5 percentage points.
Since 2002, China has gradually established a new rural cooperative medical system with the guidance of government organizations, voluntary participation of farmers, joint financing by individuals, collectives and the government, and overall planning for serious diseases. By the end of 20 12, the new rural cooperative medical system had covered about 8120,000 people, with a coverage rate of over 98%.
In 20 13, the per capita fund-raising of the new rural cooperative medical system in China reached 340 yuan, in which government subsidies at all levels increased to 280 yuan per capita, and the total fund-raising of the new rural cooperative medical system reached 270 billion yuan.
According to the Ministry of Health, in 20 13 years, the actual reimbursement rate of patients in the new rural cooperative medical system will increase by 5 percentage points compared with 50% in 20 12 years.
The coverage of the disease has expanded.
20 kinds of serious diseases are included in the protection of serious diseases.
In 20 13, the key work of the new rural cooperative medical system is to expand the coverage of major diseases, increase the compensation ratio, and avoid farmers returning to poverty due to (major) diseases.
According to the relevant person in charge of the Ministry of Health, in 20 13 years, 20 major diseases such as lung cancer will be fully promoted throughout the province. In areas where the pilot of serious illness insurance has been carried out, 20 major diseases should be given priority in the scope of serious illness insurance, and the new rural cooperative medical system should be compensated at a rate of not less than 70%.
After compensation, the part of the personal burden that exceeds the compensation standard of serious illness insurance shall be compensated by serious illness insurance at a rate of not less than 50%. After the second compensation, poor farmers will get an additional 15% of the civil medical assistance fund, making the total reimbursement ratio reach 90%.
In addition, the Ministry of Health has formulated clinical pathways for 20 major diseases, selected essential drugs, and implemented centralized procurement at the provincial level to ensure the safety of drug use for major diseases of farmers.
At the same time, the Ministry of Health requires local health administrative departments to choose the designated medical institutions of the new rural cooperative medical system with good diagnosis and treatment conditions, strong cost control ability and strong organizational management ability as the designated medical institutions for participating farmers' major diseases. Under normal circumstances, serious diseases should be diagnosed and treated in county-level medical institutions as much as possible; Complex and difficult cases are referred to tertiary medical institutions by receiving hospitals.
The Ministry of Health has issued a request that the new rural cooperative medical system agencies at all levels should simplify and standardize the reimbursement process for major diseases, actively promote the timely settlement and settlement of reports by designated medical institutions, and promote the "one-stop" service of the new rural cooperative medical system and medical assistance in light of the actual situation, so as to facilitate the timely compensation of participating farmers.
References:
Baidu encyclopedia-Medicaid for critical illness