Work Implementation Program"
The town people's governments (street offices):
"Pubei County universal commercial health insurance "Qinhui Insurance" work implementation plan "has been agreed by the county people's government, is hereby issued to you, please seriously organize and implement.
Pubei County Medical Security Bureau Pubei County Finance Bureau
December 12, 2022
Pubei County Universal Commercial Health Insurance "Qinhui Insurance"
Work Implementation Program
According to the "Zhong*** Guangxi Zhuang Autonomous Region Committee Notice of the People's Government of Guangxi Zhuang Autonomous Region Issuing ＜Implementation Opinions on Deepening the Reform of the Medical Security System＞ (Gui Fa [2020] No. 18) Notice of the Commanding Department of Guangxi's Construction of ASEAN-Oriented Financial Open Portal on the Issuance of ＜The List of Reform and Innovation Tasks of the Comprehensive Pilot Zone for Insurance Innovation (First Batch of 2021-2023)＞ (Gui Jin Portal Instruction ＞ [2021] No. 7) and Qinzhou Municipality Notice of Qinzhou Municipal Bureau of Medical Security Qinzhou Municipal Bureau of Finance Qinzhou Supervisory Sub-bureau of the China Banking Insurance Regulatory Commission on the Issuance of Qinzhou Municipality's Universal Commercial Health Insurance "Qinhui Bao" Work Implementation Program (Qin Medical Insurance [2022] No. 68), in order to build a comprehensive multi-level medical insurance system for the county, promote the integration and development of health insurance and commercial health insurance, and promote the establishment of a county-wide health insurance program for the whole county. Insurance integration and development, to promote the establishment of the county's unified localized universal commercial health insurance system, integrated to enhance the level of medical care, combined with the actual county, is now on the establishment of the county's universal commercial health insurance (hereinafter referred to as the "Qinhui insurance") system, hereby formulate the implementation of the program.
I. Guiding ideology
Taking Xi Jinping's thought of socialism with Chinese characteristics in the new era as the guidance, y implementing the views of the CPC Central Committee on deepening the reform of the medical insurance system, adhering to the people's health as the center, establishing a broad coverage, wide coverage, strong articulation, health and sustainability, stability and development of the commercial health insurance system on the basis of the county's basic medical insurance system, and effectively solving the problem of "poverty due to illness". To solve the problem of "poverty due to illness, return to poverty due to illness", and strive to alleviate the economic burden caused by the people suffering from serious illnesses, and constantly enhance the people's sense of well-being, sense of achievement and sense of security.
Second, the basic principles
(a) the government to guide, social business *** build
The government to actively promote the work of universal health supplemental medical insurance, guide and promote the integration of social health insurance and commercial health insurance development, social business *** build a multi-level medical insurance system, to meet the needs of the people's diversified protection, and to further enhance the level of medical protection of insured persons.
(2)Comprehensive coverage, easy to claim
Pubei County employees basic medical insurance and urban and rural residents basic medical insurance participants can voluntarily choose to buy "Qinhui insurance", without age, household registration, health status, past medical history, occupational type and risk of illness and other restrictions. With a low premium, ordinary insured persons can purchase the plan without any pressure, and the online insurance and claims processing is one-stop, convenient and efficient.
(3) Public welfare-oriented, capital preservation and profitability
"Qinhui Insurance" is undertaken by selected commercial insurance organizations, which should be oriented to market mechanism, capital preservation and profitability, highlighting public welfare, and the premiums raised should be used for the necessary operating costs, mainly for the payment of claims to insured persons, and should be self-supporting, and at their own risk. The premiums raised should be used mainly for the compensation expenses of the insured persons, who should be responsible for their own profit and loss. The establishment of a dynamic adjustment mechanism, reasonable adjustment of premium standards and coverage content, to ensure the sustainability of the program.
(D) policy tilt, help rural revitalization
Special difficulties of the population (special hardship cases, orphans, de facto unsupported children, low-income recipients and identify the validity of low-income objects) personnel to implement appropriate treatment tilt policy. Encouragement of employers for employees, urban and rural collective economic organizations for residents, charities and caring people for the aid recipients and specific groups of people in need to fund the purchase of "Chinhwai Insurance".
Three, the main content
(a) financing mechanism
Based on the level of economic and social development of the county, the level of basic medical insurance treatment, the demand for protection of participants and the scope of protection and other factors, scientifically determine the premium standard.
1. Premium standard: "Qinhui Insurance" annual contribution standard in principle in accordance with the previous year, Qinzhou City, the city's disposable income of residents of about 0.3% to determine the 2022-2023 "Qinhui Insurance" premium standard for each person. "The premium standard for 2022-2023 is 79 yuan per person per year. The specific standard can be dynamically adjusted, can be adjusted once a year, by the commercial insurance operators combined with the protection needs, fund balance and other factors measured, reported to the "Qinhui Insurance" work leading group to determine.
2. Premium payment: Participants can pay the premium through online and offline channels. The insurance period of "Qinhui Insurance" is one year, and 1-2 months are chosen as the centralized payment period every year. Participants are required to complete the payment before the deadline for centralized payment.
(2) Objects and Scope of Coverage
1. The objects of coverage are the county's employees' basic medical insurance and urban and rural residents' basic medical insurance participants, who can voluntarily enroll in the insurance, regardless of their age, household registration, state of health, past medical history, type of occupation, and risk of illness.
2. The scope of coverage is linked to the basic medical insurance for employees, the large medical co-ordination, the medical subsidies for civil servants, and the secondary reimbursement of large medical expenses, and is linked to the basic medical insurance for urban and rural residents, the large-scale medical insurance for urban and rural residents, and the medical assistance. And the following expenses are guaranteed:
(1) Out-of-pocket expenses. Individual out-of-pocket expenses incurred by urban employee participants during their hospitalization in medical insurance designated medical institutions that are in line with the scope of reimbursement of basic medical insurance and have been reimbursed by basic medical insurance, civil servant's medical subsidy, coordination of large medical expenses, and secondary reimbursement of large medical expenses; and out-of-pocket expenses incurred by urban and rural resident participants during their hospitalization in medical insurance designated medical institutions that are in line with the scope of reimbursement of basic medical insurance and have been reimbursed by basic medical insurance, major disease insurance, and medical aid, The individual out-of-pocket expenses incurred by urban and rural resident insured persons during hospitalization in medical insurance designated medical institutions that are within the scope of reimbursement by basic medical insurance and have been reimbursed by basic medical insurance, major disease insurance and medical assistance.
(2) Out-of-pocket drug expenses. The out-of-pocket drug expenses incurred by the insured person during hospitalization in the designated medical institutions under medical insurance (referring to the drug expenses that are in line with the scope of indications of the drug specification, the drug expenses within the medical insurance catalog exceeding the limited scope, and the drug expenses outside the medical insurance catalog).
(3) Coverage Level
The coverage level is set reasonably according to the level of medical insurance treatment, the coverage needs of the insured and the insurance rate in the county.
1. Starting line (deductible): the starting line for urban workers is 10,000 yuan, and the starting line for urban and rural residents is 15,000 yuan.
2. Payout ratio:
(1) 50% of out-of-pocket expenses from designated medical institutions within the city (including Beihai, Fangchenggang, Yulin and Chongzuo), 40% of out-of-pocket expenses from designated medical institutions outside the city, and a 5% increase in the payout ratio for people with special difficulties (special hardship case, orphans, children with no one to support them, low-protection recipients, and low-income recipients within the validity period of recognition). The percentage of compensation.
(2) 30% of out-of-pocket drug expenses incurred during hospitalization in designated medical institutions.
3. Benefit limit: The maximum amount of benefit for out-of-pocket expenses in the participating year is 1 million yuan; the maximum amount of benefit for out-of-pocket drug expenses is 1 million yuan.
(4) Payment period and insurance period
"Qinhui Insurance" participation and payment time for each year in October - December, the insurance period for the current year from December 31, 00:00 to December 30, 24:00, for a period of one year. 2022 participation and payment time for 2022 November 2, 2022 to December 22, 2022 to pay the premiums. to December 22, 2022.