Target: urban and rural low-income families and their members; Special hardship support personnel; Streamlining the old workers in rural areas; Children in distress; Key special care recipients; Poor workers and their family members; Filing personnel and temporary relief objects.
Second, the rescue fund.
1. Clarify the channels and standards for raising funds.
Raise social medical assistance funds through the following channels:
The municipal and district level finance shall arrange special subsidy funds according to a certain standard of the total resident population in the municipal area and include them in the annual financial budget of the city and district.
Every year, 65,438+00% of the local social welfare lottery public welfare fund is used for social medical assistance.
Every year, 80% of the special funds for Medicaid for special care recipients arranged by the municipal civil affairs department at all levels of finance are earmarked for social medical assistance for key special care recipients.
The Municipal Federation of Trade Unions arranges special funds according to the per capita expenditure standard of social medical assistance funds in the previous year and the number of poor workers and their family members included in medical assistance.
The superior subsidizes the special funds for social medical assistance in cities and districts.
Donation funds from citizens, legal persons, social organizations and groups.
Interest on special funds.
Other funds approved by the municipal government that can be used for social medical assistance.
Third, rescue treatment
1.___ basic object assistance treatment
Insurance payment assistance.
City "three noes" personnel to participate in the basic medical insurance for employees, the cost is fully borne by the medical assistance fund. Poor workers and key entitled groups, insurance payment funds from the original channel to solve. Other basic medical assistance objects shall participate in the medical insurance for urban and rural residents in a unified way, and the individual contributions shall be borne by the medical assistance fund.
Medical expenses assistance.
When seeing a doctor in a designated hospital, the fees for general outpatient service, emergency treatment and outpatient injection will be exempted, and the fees for hospitalization, basic medical care and ordinary beds will be halved; Buy drugs in the catalogue at designated retail pharmacies, and the drug fee will be reduced by 20%. After the above fee reduction, it shall be settled according to the relevant provisions of social medical insurance.
Out-of-pocket subsidies for medical expenses.
(a) to participate in the basic medical insurance for employees, after enjoying the basic medical insurance for employees and the supplementary medical insurance for employees, 75% of the basic medical expenses paid by individuals shall be paid by the social medical assistance fund.
For example:
On-the-job workers with medical insurance enjoy the minimum living allowance. The payment base of 202 1 is 40,000 yuan, and the account in that year was 1200 yuan, but there was no account in previous years. I went to the clinic of Jiankang Road Community Health Center due to illness, and the outpatient fee was 5,000 yuan.
One-stop settlement of medical insurance benefits and medical assistance benefits;
Account reimbursement in the current year 1200 yuan;
The "Qifubiaozhun for outpatient and emergency departments as a whole" is 2000 yuan, which originally required all individuals to pay in cash;
Overall fund reimbursement ×90%= 1620 yuan, which originally required personal cash payment1800x10% =180 yuan;
Because the insured Wang is the object of assistance, Wang had to pay 2000 yuan+180 yuan =2 180 yuan in cash, of which 75% was automatically reimbursed by the medical assistance fund, that is, 1635 yuan. Wang only needs 545 yuan for this clinic.
(II) For the recipients who participate in the basic medical insurance for urban and rural residents, 70% of the basic medical expenses for general outpatient and emergency treatment occurred in the primary medical institutions designated by me, and the individual pays part of the basic medical insurance, and the annual cumulative payment of the medical assistance fund shall not exceed 2 times of the personal payment standard of the current year. The basic medical expenses of chronic disease clinics in designated medical institutions, the individual pays part of the basic medical insurance, and the social medical assistance fund pays 75%. The annual cumulative payment of the medical assistance fund shall not exceed 4 times of the individual payment standard of that year. The annual cumulative payment ratio of the outpatient basic medical expenses for special major diseases in designated medical institutions, the individual pays part of the basic medical insurance and the medical assistance fund does not exceed 7.5 times of the individual payment standard of the year.
"Basic medical service package" assistance. For the medical assistance objects over 60 years old who participate in the medical insurance for urban and rural residents, the outpatient medical expenses incurred in the medical insurance system in the community health service institutions designated by me are 80% of the "basic medical service package" fund assistance.
2 _ _ _ Special object rescue treatment
Those who meet the conditions for emergency medical assistance due to illness, after enjoying medical insurance and social medical assistance, will be given a one-time assistance of 60% at the end of the year for the part where the accumulated medical expenses of individuals exceed10.5 million yuan. The maximum amount of relief funds is 50,000 yuan, and the required funds are borne by the "charity medical aid" funds.