2017 New Medical Insurance Policy 1: Basically realize the national network of medical insurance in 2017
The Ministry of Human Resources and Social Security held a meeting on the afternoon of the 13th to announce that the Chinese government won the International Social Security Association's "Outstanding Achievement Award for Social Security" Press briefing. Regarding the progress of direct settlement of hospitalization expenses for out-of-town medical treatment, Huang Huabo, deputy director of the Social Insurance 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. The goal is to basically achieve nationwide networking by the end of 2016 and launch Direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces; direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces began to be gradually implemented in 2017, and by the end of the year it was expanded to direct settlement of hospitalization medical expenses for people who meet the transfer regulations.
2017 New Medical Insurance Policy 2: Two major breakthroughs have been made for medical treatment in other places
In response to reporters’ questions, the relevant person in charge said that in order to ensure that hospitalization expenses for medical treatment in other places are directly covered To settle the work, the Ministry of Human Resources and Social Security established a special working group, formulated a work plan, clarified tasks, set back time, and concentrated on tackling key problems. At present, some major breakthroughs have been made, mainly in two aspects:
December On the 9th, the Ministry of Human Resources and Social Security and the Ministry of Finance jointly issued the "Notice on Direct Settlement of Inpatient Medical Expenses for Inter-Provincial Medical Treatment in Different Places for Basic Medical Care." This is the Ministry of Human Resources and Social Security issued No. 120 in 2016. The document clarifies the objectives and tasks, basic principles, main policies, settlement models, handling procedures, responsibilities of ministerial and provincial platforms, as well as some major issues such as the construction of information systems.
Last week, the national off-site medical settlement system passed preliminary acceptance. This marks the stage in which this work has shifted from policy decision-making and system construction to policy implementation and trial operation of system ministry-provincial docking. At the same time, we will strengthen local dispatch in Beijing-Tianjin-Hebei, Shanghai, Guangdong and other places, urging all localities to realize cross-regional medical insurance settlement within the province this year, and to connect with the ministerial-level system to make preparations.
2017 New Medical Insurance Policy 3: Direct settlement of out-of-town medical expenses for compliant personnel by the end of 2017
When will direct settlement of out-of-town medical expenses be realized? The Ministry of Human Resources and Social Security has also given Answer:
National networking will be basically realized in 2016. This is a keyword.
Start the direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces. A key word here is "start". In addition, there are retirees resettled in different places across provinces, not all retirees.
In 2017, we began to gradually solve the direct settlement of hospital medical expenses for retirees resettled in other places across provinces. This does not mean that it will be completed by the end of 2016, but it will be launched at the end of 2016. In 2017, the direct settlement of medical expenses for retirees resettled in other places can be directly solved. Settlement.
2017 New Medical Insurance Policy 4: 2017 Resident Medical Insurance Payment Policy
First, individual payment standards will be appropriately adjusted. As medical consumption levels increase, the state has increased fiscal subsidy funds for resident medical insurance year by year, and the individual payment standards in 2017 will also be appropriately increased. The payment standards are 60 yuan for students and children, 100 yuan for elderly residents over 60 years old, and 300 yuan for other unemployed urban residents, which will be increased by 10 yuan, 30 yuan, and 100 yuan respectively. Individuals who are eligible for subsistence allowances, persons with disabilities, and persons with "three no's" do not need to pay individual contributions.
The second is to realize "retrospective" reimbursement of newborn medical expenses. The new policy stipulates that newborns must pay to participate in the resident medical insurance within 90 days (including 90 days) from the date of birth, and the medical expenses for hospitalization for diseases occurring since the date of birth can be paid by the medical insurance fund in accordance with regulations.
Third, the outpatient appointment institution cannot "bind without authorization". Starting from January 1, 2017, insured residents only need to go to the selected outpatient appointment institution to go through the appointment procedures with the "Medical Certificate" during the first outpatient visit, and they can enjoy outpatient overall treatment according to regulations. There is no need to go through the appointment procedures in advance, and outpatient appointment institutions are not allowed to conduct "unauthorized binding" operations against the will of insured residents.
2017 New Medical Insurance Policy 5: 2017 Medical Insurance Reimbursement
1. Scope of Major Illness Medical Insurance Reimbursement in 2017
1. Treatment of malignant tumors: including chemotherapy for malignant tumors (including endocrine-specific anti-tumor therapy), radiotherapy for malignant tumors, isotope anti-tumor therapy, interventional anti-tumor therapy and traditional Chinese medicine anti-tumor therapy.
2. Outpatient hemodialysis and peritoneal dialysis treatment for severe uremia.
3. Anti-rejection treatment after kidney transplantation.
4. Treatment of serious mental illnesses: schizophrenia, depression (moderate or severe), mania, obsessive-compulsive disorder, mental retardation accompanied by mental disorders, epilepsy accompanied by mental disorders, paranoid psychosis .
It should be noted that the following situations are not covered by major illness insurance:
1. Seeking treatment in non-designated hospitals without approval (except for emergency rescue);
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2. Suffering from occupational diseases, work-related injuries or relapse of old work-related injuries; injuries caused by traffic accidents;
3. Injuries caused by personal violations;
4 .Food poisoning caused by accidents caused by liability;
5. Treatment due to suicide (except for mental illness);
6. Injury caused by medical accidents;
< p>7. According to the regulations of the state and this city, medical expenses should be paid by oneself.II. Proportion of critical illness medical insurance in 2017
1. Deposit line: 20,000 yuan. If the amount exceeds 20,000 yuan, it can be reimbursed through critical illness insurance.
2. Above the deductible line, the reimbursement ratio of critical illness insurance is:
1) 20,000 yuan to 50,000 yuan: 50% of critical illness insurance is reimbursed;
2) 50,000 yuan to 100,000 yuan: 60% is reimbursed by critical illness insurance;
3) More than 100,000 yuan: 70% is reimbursed by critical illness insurance.
3. Annual reimbursement cap: 300,000.
3. Critical illness medical insurance reimbursement process in 2017
1. Materials required for critical illness medical insurance reimbursement
1) Insured person’s ID card;
< p>2) The insured’s medical guarantee or medical insurance card;3) The original and copy of the medical expense settlement list.
2. Critical illness medical insurance reimbursement process
1) Insured persons need to bring the above materials to the medical insurance department of the local designated hospital to fill in relevant forms for preliminary review; 2) The designated hospital will enroll those who pass the preliminary review for insurance Resident information is submitted to each urban medical insurance agency for review;
3) The insured residents who pass the final review will be organized by each urban medical insurance agency to issue critical illness insurance reimbursements.
4. The reimbursement period for serious illness insurance in 2017
A maximum of two years from the date of first diagnosis or recurrence of malignant tumors, of which Chinese herbal medicine treatment for malignant tumors can be enjoyed for 5 years.
Compared with previous years, what are the changes in the new critical illness medical insurance policy in 2017? The changes are mainly reflected in the following aspects: 1. Lowering the minimum payment standard: The minimum payment standard is reduced from 20,000 yuan to 18,000 yuan.
2. Increase the reimbursement ratio: the payment ratio of adult residents, children and college students who participate in the first-tier payment increases from 60% to 65%; the payment ratio of adult residents who participate in the second-tier payment increases from 50% to 55%.
3. Over-limit subsidy increase: employee medical insurance participants will be reimbursed at 90%; resident medical insurance participants, adult residents, children and college students who pay in the first level will be reimbursed at 80%, and those who pay in the second level will be reimbursed at 80% Adult residents are reimbursed at 70%.
4. Increase in large-amount subsidies: employee medical insurance participants will be reimbursed at 75%; adult residents, children and college students who pay in the first level will be reimbursed at 60%; adult residents who will pay in the second level will be reimbursed at 50% .
5. Free vaccination for children: Children over 4 years old are eligible for the second dose of chickenpox vaccine free of charge.
Questions and answers related to the new medical insurance policy in 2017
1. How to use the money in the medical insurance card account
As we all know, employee medical insurance is generally divided into personal accounts and How to use the overall account?
The personal account can pay the following expenses:
1. Drug purchase expenses at designated retail pharmacies, outpatient and emergency medical expenses;
2. Used to purchase commercial insurance, accident insurance, etc.;
3. Medical expenses below the minimum standard of the basic medical insurance co-ordination fund;
4. More than The minimum payment standard of the basic medical insurance pooling fund shall be borne by the individual in proportion;
5. If the personal account is insufficient to pay, the person shall pay the amount.
The overall fund mainly pays for the following expenses:
1. Medical expenses for hospitalization;
2. Radiotherapy for malignant tumors, kidney dialysis, and post-kidney transplantation services Outpatient medical expenses for anti-rejection drugs;
3. For patients admitted to hospital after emergency rescue, the medical expenses for the seven days before hospitalization.
2. Scope of medical insurance reimbursement
1. The reimbursement by the medical insurance card is limited to medical expenses above hospitalization caused by diseases and some accidents in designated hospitals.
The reimbursement formula is: (total cost-threshold fee-self-pay-overexpense)*(75+age*0.2)%. Under normal circumstances, the actual reimbursement ratio ranges from 20 to 60%.
Private medicines are not reimbursed, but 80% of Class B medicines are reimbursed. There is a limit on bed fees, and some examination fees and diagnosis and treatment fees according to regulations cannot be reimbursed.
2. The reimbursement amount of the medical insurance card is 4 times the local average wage (the cumulative value within one year).
3. The money in the medical insurance card can be used to buy medicines in designated pharmacies and pay outpatient and emergency expenses, but it does not fall into the scope of reimbursement, because the money in the medical insurance card is the money in the personal medical insurance account.
4. Critical illness insurance reimbursement
After the insured person suffers from a serious illness, the personal responsibility incurred in the municipal medical insurance designated medical institution and in compliance with the municipal medical insurance regulations will be included in the resident critical illness insurance payment Scope, 50% will be reimbursed by critical illness insurance funds.
That is, the reimbursement amount = self-pay × 50%
3. Medical insurance card reimbursement ratio
In July this year, the Ministry of Human Resources and Social Security announced the "Human Resources and Social Security According to the "Thirteenth Five-Year Plan" for the Development of Guaranteed Careers, my country will stabilize the payment ratio of hospitalization expenses within the scope of the basic medical insurance policy for employees and urban and rural residents at around 75%.
IV. New uses of medical insurance cards
1. Can be used as ID cards
On October 1, 2015, the Criminal Law Amendment (9) Cards are included in the range of documents that can be used to prove identity according to law. Anyone who forges, alters, or buys or sells social security cards will be held criminally responsible in accordance with the law; anyone who uses forged, altered, or embezzled other people's social security cards will be held criminally accountable in accordance with the law.
2. Can be used for fitness in some provinces and cities
In the second half of this year, in some provinces and cities in Shandong, Chongqing, and Jiangsu, employees can use their personal account balances to carry out fitness activities in fitness venues. However, it cannot be used to purchase food, clothing, fitness equipment, or withdraw cash.
5. Things to note when using medical insurance cards
1. Cashing out is prohibited
No unit or individual may violate the usage scope and requirements of medical insurance cards, and cashing out is strictly prohibited cash.
2. Medical insurance cards in some provinces and cities can be used by the whole family
Starting from the second half of this year, in some provinces and cities, such as Zhejiang Province and Guangzhou City, the balance of medical insurance personal accounts over the years can be used for Pay the medical security expenses for spouses, children, parents and other close relatives of the employees' basic medical insurance participants to achieve mutual financial assistance among family members.
3. Medical insurance will not pay under the following circumstances
Those who seek medical treatment at non-designated medical institutions or purchase medicines at non-designated retail pharmacies (except for emergencies);
due to personal reasons Self-injury caused by fighting, drug abuse or other illegal activities;
Treatment due to alcoholism, suicide, self-mutilation, etc.;
Injured due to traffic accidents, medical accidents or other liability accidents Injury;
And situations where the individual should pay for it according to national or local regulations.
6. How to check the balance of the medical insurance card
Insured persons can call the 12333 social security consultation hotline or check the balance of the personal medical insurance account through Bank of China Savings Bank, urban designated hospitals, pharmacies, etc. .
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