II. Consolidate and improve the treatment level
III. Effectively cover the bottom line of people's livelihood protection
IV. Promote the standardization and unification of the system
V. Do a good job in the management of healthcare insurance payment
VI. Strengthen the centralized banded procurement of medicines and consumables and the management of their prices
VII. Strengthen the supervision of the fund and the analysis of its operation
VII. Analysis
VIII. Improvement of health insurance public **** management services
IX. Advancement of standardization and informatization construction
X. Improvement of organization and implementation
(1) After receiving reimbursement from the New Rural Cooperative Medical Care System or the basic medical insurance for urban residents and compensation from the insurance for major illnesses, the special hardship dependent persons will be given assistance in accordance with the policy of 100% of the out-of-pocket portion of the individual's payment. After receiving reimbursement from the new rural cooperative medical insurance or urban residents' basic medical insurance and compensation from major disease insurance, they will be given assistance at 100% of the individual's out-of-pocket expenses within the scope of the policy, with a maximum annual total of 15,000 yuan.
(2) In case of hospitalization of urban and rural low-income people, after obtaining reimbursement from the New Rural Cooperative Medical Care or the basic medical insurance for urban residents and compensation from the major disease insurance, assistance will be given according to 70% of the out-of-pocket expenses of individuals within the scope of the policy, with a maximum annual total of 10,000 yuan.
(3) For urban and rural low-income families suffering from major illnesses or chronic illnesses as stipulated in the Measures, if they are hospitalized, after receiving reimbursement from the New Rural Cooperative Medical Care or basic medical insurance for urban residents and compensation from the major illness insurance, they will be given assistance according to 50% of the out-of-pocket expenses within the scope of the policy after deducting 5,000 yuan, with a cumulative maximum of 8,000 yuan per year.
(d) medical assistance for the poor population in accordance with the "Anhui Province, rural poor people comprehensive medical insurance system implementation plan" (Anhui Wei Cai [2016] No. 22), the standard of assistance for the annual hospitalization of the total cost of complying with the medicine (including special chronic disease outpatient) of 10% of the subsidies given. The amount of subsidy shall not exceed the remaining compliant costs after compensation by basic medical insurance and major disease insurance.
(E) Preferential policies for special diseases
Sufferers of uremia, leukemia requiring long-term dialysis of serious illnesses are not subject to the above annual cap line, and can be assisted with an annual maximum of 15,000 yuan;
I. Scope of medical aid recipients
Medical aid equitably covers workers in difficulty and urban and rural residents who have a heavier burden of medical expenses, and is implemented based on the categories of aid recipients. Categorized assistance. Low-income recipients, special hardship cases, low-income marginalized family members, and the rural poverty-prone population included in the scope of monitoring, in accordance with the provisions of the aid. For patients with serious illnesses (hereinafter referred to as patients with serious illnesses resulting in poverty due to illness) who do not meet the requirements for low income, special hardship case assistance and support, or families on the fringe of low income, but whose families are experiencing serious difficulties in their basic livelihoods as a result of high medical expenses, a certain amount of assistance is provided in accordance with the rules and regulations. The conditions for recognizing patients suffering from serious illnesses due to poverty caused by illnesses shall be formulated separately by the Tangshan Civil Affairs Bureau in conjunction with the Tangshan Bureau of Medical Security and other relevant departments, taking into account the family's financial situation, medical expenses, medical insurance payments, and other circumstances. Population out of poverty, return to poverty, not included in the monitoring of the rural population vulnerable to return to poverty, in accordance with the city's consolidation and expansion of medical insurance to combat poverty effectively connect the rural revitalization strategy relevant policies and regulations to give assistance.
Two, medical assistance standards
(a) general medical assistance for special hardship cases, low income recipients do not have a starting standard. Low-income marginal family members, included in the monitoring of the rural population vulnerable to return to poverty, the starting standard is 3,000 yuan. The starting payment standard for people suffering from serious illnesses caused by diseases is RMB 8,500 yuan. After the applicant has been reimbursed by the basic medical insurance and the urban and rural residents' major disease insurance for the individual part of the medical expenses incurred by the outpatient chronic and special diseases or hospitalization within the scope of policy in the designated medical institutions, the applicant shall be given 80% of the relief for the people with special difficulties within the limit of the annual relief, 70% of the relief for the people with low income, 67% of the relief for the family members of marginal members of the low income, the rural poor people who are prone to return to poverty and the people who suffer from the serious disease due to the disease, and 67% of the relief for the people with low income. 67%. The cumulative annual limit of assistance for the recipients shall not exceed 50,000 yuan.
(2) the medical aid for serious illnesses and standardized referral and in the provincial designated medical institutions for the aid recipients, by the "three-fold system" comprehensive protection after the policy within the individual burden is still heavy, to give tilted aid. For out-of-pocket medical expenses exceeding the annual maximum payment limit for assistance, the excess portion of the assistance is provided at a certain percentage: 80% of the standard assistance for special hardship cases and low-income recipients, with a cumulative limit of no more than 80,000 yuan for annual assistance; 70% of the standard assistance for other recipients, with a cumulative limit of no more than 60,000 yuan for annual assistance. People in need with multiple special status attributes shall enjoy assistance according to the principle of higher rather than lower, and shall not be subject to repeated assistance.
Legal basis;
Interim Measures for Social Assistance
Article 30: Application for medical assistance shall be submitted to the township people's government, street offices, after examination and publicity, by the people's government of the county-level civil affairs departments for approval. Medical assistance for members of the minimum subsistence guarantee and special hardship dependents shall be handled directly by the civil affairs departments of the people's governments at the county level.