Medical aid for major illnesses refers to a new type of medical aid system that relies on the settlement platform of basic medical insurance for urban residents (employees) and new rural cooperative medical care, with stable financial inputs, service platforms*** use, information resources*** enjoyment, synchronization of settlements and payments, standardized management and operation, and obvious relief effects, and is able to provide fast services for the needy, covering both urban and rural areas in a scientific and standardized manner. So what are the policy provisions of Guangxi's major disease assistance? What is the reimbursement ratio and reimbursement scope of Guangxi's major disease assistance? The following content is for reference only!
Guangxi comprehensively carry out the work of medical assistance for serious illnesses
5 categories of people 27 kinds of diseases can apply for assistance
The annual cumulative maximum limit of assistance for special hardship dependents is 10,000 yuan
For low-income families, if one person suffers from a serious illness, the whole family life may not be guaranteed! How to solve this situation? A few days ago, the regional government issued a "notice on the comprehensive implementation of medical assistance for serious illnesses" (referred to as "Notice"), comprehensively carry out the work of medical assistance for serious illnesses.
Relief object
5 categories of people
can enjoy medical assistance
"Notice" stipulates that there are five categories of people, in addition to enjoying the basic medical insurance benefits of the masses, the special hardship to support the people, the minimum subsistence guarantee family members are also included in the relief object. Among them, one, two, three categories of people is the focus of medical assistance for serious illnesses, four, five categories of people by the localities according to the funding situation gradually into the scope of medical assistance for serious illnesses.
The five categories of people who receive medical assistance for serious illnesses are
Category 1 people: people in special hardship;
Category 2 people: members of the Minimum Livelihood Guarantee (MLG) family;
Category 3 people: low-income urban and rural family members enjoying the benefits of urban workers' medical insurance or basic medical insurance for urban residents and the new type of cooperative medical care in the countryside (hereinafter referred to as the relevant basic medical insurance).
Category 4: family members who are entitled to the relevant basic medical insurance, and who have serious difficulties in basic living due to high medical expenses exceeding the family's affordability;
Category 5: family members who are entitled to the relevant basic medical insurance, and who are in special difficulties as stipulated by the people's governments at or above the county level.
Scope of assistance
27 kinds of diseases
Can enjoy the big disease assistance
How can I enjoy the big disease assistance? When the aid recipients suffered from 27 kinds of serious illnesses within the scope of the provisions of the basic medical insurance, urban and rural residents of the big disease insurance, all kinds of supplementary medical insurance, commercial insurance compensation (reimbursement), a diagnosis and treatment process or the same kind of disease annual total personal out-of-pocket compliance medical expenses still exceed 30,000 yuan, will be included in the serious illnesses of the medical aid.
Newborns (infants) born in the same year, but born more than the basic medical insurance payment period, the implementation of the "mother and child bundling" policy, along with the mother eligible for medical assistance for serious illnesses included in the assistance for serious illnesses (the standard of assistance and the ceiling line is treated as the same as a person).
27 critical illnesses include
Acute leukemia in children, congenital heart disease in children, breast cancer, cervical cancer, severe mental illness, end-stage renal disease (chronic kidney disease stage 5, including outpatient treatment), multidrug-resistant tuberculosis (including outpatient treatment for tuberculosis), opportunistic infections in AIDS, cochlear implantation for children with severe hearing loss, hemophilia (including outpatient treatment)
In addition, people suffering from serious illnesses that require long-term outpatient treatment, resulting in higher out-of-pocket expenses for categories 1 and 2, can follow the provisions on outpatient assistance in the relevant measures. For example, those suffering from end-stage renal disease (chronic kidney disease stage 5), multidrug-resistant tuberculosis, hemophilia. If you need long-term outpatient treatment, the cost of outpatient treatment is included in the cost of inpatient medical assistance for serious illnesses.
Rescue standards
A class of people annual aid
Maximum limit of 10,000 yuan
For hospitalized patients with serious illnesses, a class of people (including special hardship cases who are not enrolled in the insurance system) inpatient medical aid for serious illnesses, according to the 100 percent of the costs that should be included in the aid to the aid, the maximum limit of the annual cumulative aid for 10,000 yuan; a second-class people. Hospitalization medical assistance for serious diseases for Category 2 persons is provided at 80% of the costs that should be included in the assistance, with an annual cumulative maximum of 5,000 yuan. The second category of people who are not enrolled in the insurance, the costs of their accrued assistance is correspondingly reduced by half; three, four, five categories of people hospitalized medical assistance for serious illnesses, according to the accrued assistance costs of 70% of the assistance given, the annual cumulative maximum limit of assistance for 3,000 yuan.
Rescue objects for the "Notice" of the provisions of the first, second and third categories of people, you can apply to the hukou location of the street office (township government), by the county-level civil affairs departments to investigate, identify, and obtain approval after the rescue. Four, five categories of people's relief procedures by the local reference to the relevant documents to develop their own, these two categories of people can be in the local consulting specific procedures.
In addition, if the aid object category changes, according to the highest category of standard can enjoy the aid, but can not repeat the aid; aid objects across the year hospitalization, according to the two years were given hospitalization medical aid; need to be transferred to out-of-area treatment, according to the autonomous region of the relevant out-of-area medical management methods and other documents required to handle the transfer procedures and apply for medical aid. In the out-of-area medical treatment of serious illnesses medical aid recipients, according to should be counted as 50% of the cost of aid to be reimbursed, but can not exceed the same type of aid recipients of the annual maximum limit of 70% of the aid.
For those who are not enrolled in the second category, the relevant basic medical insurance agencies and major medical insurance contractors at or above the county level where they are domiciled are responsible for helping to approve the hospitalization medical expenses, issuing basic medical insurance and major medical insurance compensation (reimbursement) vouchers or medical expense accounting sheets, and stamping the compensation, reimbursement vouchers or accounting sheets with a seal to be determined.
Rescue procedures
Improve the "one-stop"
Instant settlement mechanism
For how to reimburse the problem, the "Notice" also has clear requirements, the region should be combined with the basic health insurance, major medical insurance and medical assistance work to accelerate the improvement of The "one-stop" instant settlement mechanism, relying on the existing medical aid information system to establish an instant settlement system for medical aid for serious illnesses, realizing the interconnection of basic medical insurance, major illness insurance and medical aid information management system, as well as the need for information on patients, diagnosis and treatment, and medical expenses between the various basic medical security systems **Hanging, it is convenient for the aid recipients to go to the medical clinic to enjoy the benefits. *The system is designed to make it easier for the recipients to receive medical treatment and to minimize the requirements for the recipients in the declaration of materials and verification of information.
At the same time, the designated medical institutions to open medical assistance and basic medical insurance, major medical insurance synchronization settlement of the payment window, posted medical assistance medical guide, regularly announced the situation of medical assistance, accept social supervision. The relevant departments to exchange *** enjoy the compensation (reimbursement) data of the object of medical assistance for serious illnesses, the medical expenses incurred by the key assistance object first by the designated medical institutions to advance the medical assistance fund to pay part of the assistance object only to pay the part of the self-payment.
9, the General Office of the People's Government of the autonomous region on the issuance of Guangxi health care service system planning (2016-2020) notice, requiring that by 2020, the region per 1,000 resident population of health care institutions beds configured to increase from the 2015 4.47 to 5.53.
The notice also requires that by 2020, will realize the full population information, electronic health records and electronic medical records of the three major databases basically cover the region's population and information dynamic update. Comprehensively built interconnected autonomous regions, cities, counties, three-level population health platform, to achieve public **** health, family planning, medical services, medical insurance, drug supply, integrated management of the six business application systems of interoperability and business synergies. Popularize the application of residents' health card, and actively promote the residents' health card and social security card, financial IC card, citizen service card and other public **** service card application integration, to realize the medical "one card".
In addition, by 2020, to achieve each township to run a standardized township health center; in each street office or every 30-100,000 service population, planning to set up a community health service center. Comprehensive consideration of the level of urbanization, geographic location, the degree of population concentration and other factors, the implementation of the central township health center service capacity enhancement project, focusing on the construction of the existing 288 central township health centers.
;