From the Kunming City Health Insurance Center was informed that, at present, the number of urban workers, urban and rural residents in Kunming region, the number of 5,804,800 people, the insurance coverage rate of more than 95%, all the participants are included in the scope of coverage of the supplemental medical insurance for the major diseases.
It is understood that the supplemental medical insurance for major illnesses is to reimburse participants for high medical expenses incurred due to illness, an insurance system, supplemental medical insurance for major illnesses is the "amount" of the concept, not the "disease" concept, that is, the insured workers basic The concept of "amount", not "type", is that the basic payment of the insured workers and the individual out-of-pocket payment of the insured residents reaches the limit stipulated in the relevant policy, which can automatically start the payment of the supplemental medical insurance fund for major illnesses, and there is no need for any formalities.
Kunming launched the urban workers' medical insurance, the new rural cooperative medical care and the urban residents' basic medical insurance system in 2001, 2003 and 2007, respectively. 2001, Kunming launched the urban workers' basic medical insurance system at the same time as the urban workers' supplemental medical insurance for major illnesses. When enrolling in the insurance system, the insured workers are required to pay both the basic medical insurance premiums and the supplemental medical insurance premiums for major illnesses, and enjoy both the basic medical insurance benefits and the supplemental medical insurance benefits for major illnesses. At present, the total payment limit of Kunming urban workers' medical insurance is 259,000 yuan, and the average reimbursement ratio of medical expenses within the policy scope is around 83%.
In 2013, Kunming was listed as one of the pilot cities in the province to carry out supplemental medical insurance for urban and rural residents, and took the lead in the province to carry out supplemental medical insurance for urban and rural residents.
On January 1, 2013, Kunming launched the implementation of the "Implementation Measures for Supplemental Medical Insurance for Urban and Rural Residents of Kunming City", which integrates the two systems of urban residents' medical insurance and the new type of rural cooperative medical care into one system. system, fully realizing "the same insurance in the same city, the same treatment in the same city". Kunming urban and rural residents who are insured can enjoy basic medical insurance and supplementary medical insurance for major illnesses after they have made contributions to the insurance. At present, the maximum payment limit of urban and rural residents' medical insurance is 158,000 yuan, and the average reimbursement ratio of medical expenses within the policy scope is about 70%.
It is reported that the next step, Kunming City Health Insurance Center will further improve and perfect the policy and system of supplemental medical insurance for major diseases, strengthen the analysis and research on the operation of supplemental medical insurance for major diseases, explore the establishment of a stable, multi-channel, sustainable financing methods, and to ensure that the fund balance of revenues and expenditures in the case, adjust and improve the level of treatment of urban and rural residents with supplemental medical insurance for major diseases at an appropriate time. At the same time, the supervision of the medical insurance fund will be comprehensively strengthened in a variety of ways to ensure the safety of the medical insurance fund. First, standardize the management of designated medical institutions, strict access, exit mechanism, the supervision will be extended to the medical insurance physician; second, to maintain the investigation and handling of irregular designated medical institutions of the high-pressure situation, and unremitting; third, pay attention to the monitoring of data analysis, and strive to improve the relevance of the work of the audit, accuracy and effectiveness; fourth, the construction of medical services intelligent monitoring system.