Medical assistance for serious illness refers to a new medical assistance system that relies on the basic medical insurance for urban residents (employees) and the settlement platform of the new rural cooperative medical system, with stable capital investment, * * * using the service platform, * * * enjoying information resources, synchronizing settlement and payment, standardized management and operation, obvious relief effect, fast service for people with difficulties and scientific coverage of urban and rural areas.
Medical assistance for serious illness adopts the five-in-one model of "financing participation, basic medical expenses reduction, special outpatient assistance, hospitalization medical assistance and serious illness charity assistance" as medical assistance for serious illness. The recipients need not apply, examine and approve in person, but can be directly included in the database of urban and rural medical insurance and medical assistance, and fully implement the synchronous settlement service of basic medical expenses reduction, medical insurance compensation, medical assistance and individual self-financing.
One,
Employee medical insurance includes employee basic medical insurance and employee supplementary medical insurance. The basic medical insurance for employees is a social medical insurance that guarantees the basic medical rights of employees according to law. Supplementary medical insurance is not enforced by national legislation, but is voluntarily participated by employers and individuals. Basic medical insurance and supplementary medical insurance are not contradictory, but complementary and irreplaceable, and their purpose is to provide medical security for employees.
Employee medical insurance includes employee basic medical insurance and employee supplementary medical insurance. The basic medical insurance for employees is a social medical insurance that guarantees the basic medical rights of employees according to law. Enforced by laws and regulations, the basic model of combining social pooling medical funds with individual medical accounts is implemented. Like pension, work injury, unemployment and maternity insurance, it is the basic insurance item of social insurance. Supplementary medical insurance is a form of supplementary medical insurance encouraged by the state, which is organized or participated by enterprises on the basis of participating in urban basic medical insurance.
Medical insurance for employees is mainly divided into basic medical insurance for employees and supplementary medical insurance for employees.
Fold the scope of diagnosis and treatment projects for which basic insurance does not pay.
(1) service items
1, registration fee, out-of-hospital consultation fee, medical record fee, etc.
2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for name calling operation, high quality and good price, and special care by oneself.
(2) Non-disease treatment projects
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects;
5, tooth deformity, dental porcelain;
6, all kinds of medical consultation (excluding psychiatric consultation), medical appraisal.
(3) Diagnostic equipment and medical materials.
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(4) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
Fold the scope of diagnosis and treatment items that the basic medical insurance pays part of the expenses.
(a) diagnosis and treatment equipment and medical materials
1, using X-ray computed tomography (CT), stereotactic radiotherapy device (γ knife, χ knife), cardiac and angiographic X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3. Pacemakers, artificial joints, intraocular lenses, vascular stents, etc. replace artificial organs in vivo and place materials in vivo;
4, the provisions of the provincial price department can be charged separately for disposable medical materials.
(2) Treatment items
1, hemodialysis, peritoneal dialysis;
2. Transplantation of kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow;
3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Second,
Medical assistance for serious illness refers to a new medical assistance system that relies on the basic medical insurance for urban residents (employees) and the settlement platform of the new rural cooperative medical system, with stable capital investment, * * * using the service platform, * * * enjoying information resources, synchronizing settlement and payment, standardized management and operation, obvious relief effect, fast service for people with difficulties and scientific coverage of urban and rural areas.
Rescue object
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(two) urban workers who have no ability to work, no source of economic income, and no dependents (hereinafter referred to as "three no-workers" in cities and towns);
(three) the minimum living guarantee for urban and rural residents;
(four) to enjoy the regular quantitative living allowance of the civil affairs department in the 1960s;
(five) the key entitled groups who enjoy regular pensions and subsidies from the civil affairs departments;
(6) Poor workers approved by the Federation of Trade Unions;
(seven) urban and rural low-income family members.
Rescue form
Medical assistance for serious illness takes the five-in-one way of "financing participation, basic medical expenses reduction, special outpatient assistance, hospitalization medical assistance and serious illness charity assistance" as medical assistance for serious illness. The relief object can be directly included in the urban and rural medical insurance database without individual application, review and approval, and the synchronous settlement service of basic medical expenses reduction, medical insurance compensation, medical assistance and personal conceit can be fully implemented.