Xingtai Long-term Care Insurance is a social insurance system that provides basic living care and medical care services for insured persons who are in a state of long-term incapacity or semi-incapacity due to old age, illness or disability.
2. What is the coverage of long-term care insurance?
Any insured person who participates in Xingtai City's basic medical insurance shall participate in Xingtai City's long-term care insurance.
3. What are the financing channels of long-term care insurance?
The long-term care insurance fund of Xingtai City is financed through multiple channels in accordance with the principle of "determining expenditures on the basis of revenues, balancing revenues and expenditures, and having a slight surplus", and the financing channels mainly include the transfer of the medical insurance fund, individual contributions, welfare lottery public welfare funds, subsidies from the government and other relevant departments, and subsidies from other sources. Encourage enterprises, units, charitable organizations and other social groups and individual financial contributions.
4. What are the financing standards for long-term care insurance?
Long-term care insurance financing standards for the time being at 50 yuan per person per year financing. With the operation of the fund and the continuous development of economic conditions, the financing standard will be adjusted as appropriate according to the actual situation.
Long-term care insurance to establish the initial municipal urban workers funding standard is temporarily set at 50 yuan per person per year, of which: individuals pay 10 yuan per person per year, 35 yuan per person per year of the integrated fund, financial subsidies of 2 yuan per person per year, Fukushima subsidies of 3 yuan per person per year.
5, long-term care insurance individual contribution part of how to pay?
Participating in the basic health insurance for urban workers at the municipal level by their units at the beginning of the year with the health insurance premiums for a one-time withholding, or by the unit to apply for withholding from the individual account of their health insurance; urban and rural residents to participate in the basic health insurance, along with the health insurance premiums and pay.
6. What are the contents of long-term care insurance services?
Including, but not limited to, the following:
①Regular rounds, observation of the condition, detection of blood pressure, temperature, pulse, respiration, etc., according to the doctor's orders to perform oral . Injection and other routes of administration;
② basic care, specialized care, special care according to the level of care, strict standardization of disinfection and isolation measures;
③ disposal and care of urinary catheters, gastric catheters, fistula tubes and other tubes, guidance and implementation of fistula care, suction care, pressure ulcer prevention and care, dressing change, bladder irrigation, and the implementation of oral cavity care, perineal douche, bedside shampooing, general specialized care;
④Collection and delivery of specimens;
⑤Instruction on the use of oxygenator and ventilator;
⑥Timely handling of patients with major changes in condition, and assisting in referral when necessary;
⑦On the basis of nursing assessment, nutritional guidance, psychological counseling, rehabilitation therapy and hygiene education for patients, health education and rehabilitation guidance for patients and their families, and psychological counseling for patients and their families. Health education and rehabilitation guidance, psychological intervention;
8 hospice care for terminal patients, through care and symptomatic treatment, alleviate pain and maintain the dignity of life.
7, what circumstances can declare long-term care insurance?
Those who have been bedridden for a long time for more than 30 days due to old age, illness or disability, and are expected to remain bedridden for more than 3 months, and who are unable to take care of themselves, and whose conditions are basically stable and in need of long-term life care and medical care, can apply for long-term care insurance treatment.
8. What are the forms of long-term care insurance services?
There are three forms of long-term care insurance services in Xingtai:
medical specialized care, institutional care and home care.
9, long-term care insurance application materials required to prepare:
① "Xingtai City municipal urban workers long-term care insurance application form";
② social security card;
3 hospitalization medical records of the second level and above or related materials.
10, long-term care insurance declaration and appraisal process:
by the person or his family members through the contractor, the proposed selection of fixed-point service organizations, long-term care insurance system online application. The contractor regularly organizes and arranges two experts to conduct on-site assessment of the applicant's incapacity level, and makes the conclusion of the incapacity level assessment within seven working days, and the adopted persons are publicly announced for seven days, and the notice of the conclusion of the incapacity level assessment is issued after the end of the public announcement.
11, long-term care insurance treatment standards and reimbursement rates?
Long-term care insurance treatment does not set a starting line, according to the following standards:
Participating employees receive medical care, institutional care during the period of medical care costs incurred in accordance with the provisions of the corresponding standard reimbursement of 65%;
Participating employees outside the integrated area of the fixed-point service institutions to receive medical care, the reimbursement rate is reduced by 10%.
Long-term care insurance costs are "lump-sum, no compensation for overspending", according to the form of medical care services, the medical qualifications and service capacity of the designated service institutions, to determine the lump-sum standard. Bed-day lump-sum management is implemented for specialized medical care and institutional care. The lump sum amount is implemented according to the following conditions:
The form of service level bed day lump sum amount reimbursement amount
Medical specialized care level 1
Medical institutions 90 yuan/day 58.5 yuan/day
Medical specialized care level 2
And above medical institutions 120 yuan/day 78 yuan/day
Institutional care 50 yuan/day 32.5 yuan /day
Participants enjoying home care are entitled to about six services per month, each of which lasts no less than 90 minutes, at a cost of RMB 120 each time, and are reimbursed by the Long-Term Care Insurance Fund at 85% of the standardized flat rate.
The reimbursement standard in other counties can be consulted with local agencies.
12. What does the long-term care insurance payment scope include?
Fixed payment costs include medicine, medical care service fees, bed fees, equipment use fees, consumables and so on.
13. How are long-term care insurance expenses reimbursed?
The costs incurred by insured persons receiving long-term care insurance services are borne by both the insured persons and the long-term care insurance fund***. The long-term care insurance fund is partially advanced by the fixed-site service organization, and the agency settles with the fixed-site service organization on a quarterly basis; the part of the individual's burden is settled between the insured person and the fixed-site service organization. In principle, every three months for the middle of the settlement; need to interrupt or end of medical care services, can be handled at any time for the settlement and discharge procedures.
If the expenses incurred by a participant receiving long-term care insurance services cannot be settled directly with the service organization, the participant or his/her family members will make manual reimbursement after examination by the contractor with the originals and photocopies of the social security card, hospitalization bills, hospitalization expense schedule, full set of medical records, diagnostic certificates, Application Form for Long-Term Care Insurance for Urban Employees of the Municipality of Xingtai and the bank card. .
14. What cases will not be paid by the long-term care insurance fund?
1) should be paid by the basic medical, maternity, workers' compensation insurance;
2) should be borne by a third party in accordance with the law;
3) has been included in the scope of the protection of persons with disabilities, military disability pensions, prevention and treatment of mental illness and other national laws and regulations;
4) other cases.
15. Are the assessment results valid for life?
The assessment results are not valid for life. The eligibility for long-term care insurance treatment is reviewed once a year, and the treatment is deferred if it passes the annual review. Meanwhile, the designated service organizations will formulate medical care plan according to the patient's condition in a timely manner, and carry out assessment of the effect every three months, and adjust the plan according to the effect or changes in the condition in a timely manner. After the assessment to restore the ability to live on their own, stop enjoying long-term care insurance treatment.
16. What is the long-term care insurance organization?
The agency refers to the organization responsible for long-term care insurance fund-raising, payment and settlement, handling services and daily agreement management.
17 What is a long-term care insurance contractor?
The contractor refers to the commercial insurance companies that have the qualification of long-term care insurance contractor and have signed the service agreement with the organizer through public bidding.
18. What is a designated service organization for long-term care insurance?
A designated service organization is a medical, pension or other third-party service organization in the region that is qualified and has signed a long-term care insurance service agreement with the Agency.
19. Municipal long-term care insurance designated service organizations