(1) Pay the medical insurance fee. In 2022, the basic medical insurance payment standard for urban and rural residents will be 320 yuan per person; The government will give full subsidies to groups such as poor dependents, minimum living guarantee objects, orphans and children who are actually neglected, and key special care recipients; The government grants subsidies to 290 yuan to severely disabled people, people who enjoy the poverty alleviation policy during the transition period, unstable households who have not eliminated the risk of being included in the national anti-poverty monitoring information system platform during the transition period, people who are vulnerable to poverty and people who suddenly have serious difficulties.
(2) Hospitalization
1, hospitalization Qifubiaozhun and reimbursement ratio of designated medical institutions at all levels.
(1) reimbursement for hospitalization in Changyuan City: the threshold for hospitalization at township level is 100 yuan, and the reimbursement ratio is 90%; The threshold for hospitalization in county-level hospitals is 200 yuan, and the reimbursement rate is 83%. The qifubiaozhun for county hospitals and hospitals of considerable scale is 400 yuan, with 63% for 400- 1500 yuan and 83% for 1500 yuan and above. Qifubiaozhun for hospitalization in county-level tertiary hospitals within 500 yuan is 60% for 500- 1500 yuan and 80% for those above 1500 yuan.
(2) reimbursement for hospitalization outside Changyuan City: the minimum payment standard for hospitals in cities and counties is 800 yuan, with 55% reimbursement for 800-3,000 yuan and 75% reimbursement for hospitals above 3,000 yuan; Qifubiaozhun for municipal, county-level and below tertiary hospitals is 1200 yuan, 53% for 1200-4000, and 72% for more than 4,000 yuan; Qifubiaozhun for provincial level II and below hospitals is 800 yuan, with 53% for 800-4,000 yuan and 72% for more than 4,000 yuan; The minimum threshold for provincial tertiary hospitals is 2000 yuan, 50% for 2000-7000 yuan, and 68% for more than 7000 yuan; Qifubiaozhun for medical treatment outside the province is 2000 yuan, 50% for reimbursement of 2000-7000 yuan, and 68% for reimbursement of more than 7000 yuan.
2./kloc-children under 0/4 years old (including 14 years old) and elderly people over 80 years old (including 80 years old) are reimbursed in hospital. The minimum threshold for insured residents 14 years old (including 14 years old) is halved. At the time of discharge, the reimbursement rate of the elderly aged 80 years or older (including 80 years old) increased by 5%, up to 95%. Other insured residents are hospitalized at or above the county level (including the county level) for the second time and later, and the Qifubiaozhun is halved.
3, the insured residents maternity reimbursement. The medical expenses of hospital delivery for pregnant women who participate in urban and rural residents' medical insurance are paid in a fixed amount, natural delivery in 600 yuan, cesarean section 1.600 yuan. The actual hospitalization expenses are settled according to the facts below the quota standard, and those exceeding the quota standard are paid according to the quota standard.
4. Medical care for newborns. In the year when the newborn was born, parents who participated in the basic medical insurance automatically obtained the insurance qualification and enjoyed the medical insurance benefits for urban and rural residents in that year; The newborn's household registration is in Changyuan City, and if the father and mother participate in the medical insurance for urban workers, they can apply for the medical insurance benefits of the year after submitting the materials for examination and approval according to the policy; Newborns registered in Changyuan City shall be registered free of charge within 90 days of birth by the guardian with the newborn household registration book and birth certificate.
5. Reimbursement for serious illness. 34 diseases such as childhood acute lymphoblastic leukemia, cleft lip, cleft palate, breast cancer, cervical cancer, lung cancer, esophageal cancer, gastric cancer, colon cancer and rectal cancer are included in the scope of critical illness protection. Fill in the application form, register for the record, and go to the designated place in the province for medical treatment. There is no minimum threshold, and the reimbursement rate is 80% at the county level, 70% at the municipal level and 65% at the provincial level.
The maximum payment limit of basic medical insurance is 6.5438+0.5 million yuan.
(2) Outpatient medical treatment
1, outpatient co-ordination compensation. See a doctor in all designated hospitals and village clinics in the city, and enjoy the annual reimbursement policy for outpatient services in 400 yuan. The reimbursement rate of outpatient service in county hospitals is 30%, and the daily reimbursement limit is 60% in 40 yuan, 60% in township hospitals, 60% in 40 yuan, 60% in village clinics, and 60% in 20 yuan.
2, "two diseases" (hypertension, diabetes) reimbursement policy. There is no qifubiaozhun for "two diseases", and the reimbursement ratio is 60%. The annual cumulative reimbursement amount of "two diseases" and the annual cumulative reimbursement amount of outpatient co-ordination are calculated together, and the reimbursement amount is 450 yuan. The original family account (personal account) can be used for outpatient medical expenses of insured residents.
3, outpatient severe chronic diseases. 33 kinds of chronic diseases, such as severe complications of diabetes, sequelae of acute cerebrovascular disease and rheumatoid arthritis, are included in the outpatient chronic disease (42 poor households) security, with no minimum threshold, reimbursement rate of 75%, fixed-point treatment and monthly quota.
4, outpatient serious diseases. 35 kinds of outpatient diseases, such as end-stage renal disease, non-small cell cancer and hyperthyroidism, will be included in the scope of serious outpatient diseases. Except for outpatient peritoneal dialysis reimbursement of 85%, the other outpatient diseases are 80%, and the reimbursement rate of poor households enjoying the policy is 85%.
Second, the reimbursement policy of serious illness insurance
After reimbursement of basic medical insurance, urban and rural residents who pay more than 65,438 yuan+0.65,438 yuan +0.0000 yuan can enjoy the treatment of serious illness insurance, of which 60% will be reimbursed by 65,438 yuan+0.65,438 yuan +0.0000 yuan (including 65,438 yuan +0.0000 yuan). 65,438+70% for the part above 10,000 yuan; You can reimburse up to 400,000 a year.
Third, get rid of poverty and enjoy the treatment of policy personnel.
(1) critical illness insurance
Serious illness insurance continues to give preferential policies to those who enjoy poverty alleviation policies. The deductible line of serious illness insurance is 5,500 yuan, and the reimbursement rate of medical expenses within the scope of personal insurance policy is 5,500 yuan-65,438+10,000 yuan (including 65,438+10,000 yuan), with 85% reimbursement; The part exceeding 654.38+10,000 yuan shall be reimbursed according to the proportion of 95%. Cancel the annual reimbursement cap line of serious illness insurance for rural poor people.
(2) Supplementary insurance for major diseases
Those who participate in the basic medical insurance for urban and rural residents in our county and enjoy the policies of poverty alleviation, subsistence allowance and five guarantees can enjoy supplementary insurance for serious illness of people in need. The critical illness supplementary insurance deductible for people with difficulties is 3,000 yuan, and the part exceeding the deductible is reimbursed in proportion: 30% of 3,000-5,000 yuan (including 5,000 yuan); 5000- 10000 yuan (including 10000 yuan) shall be reimbursed by 40%; 10000- 15000 yuan (including 15000 yuan) 50%, 15000-50000 yuan (including 50000 yuan) 80%, more than 50000 yuan 90%, no capping line.
Fourth, the medical assistance policy for people in need.
(a) medical assistance security object
1, the minimum living security object; 2. The support object is weak; 3. Poverty alleviation policies and key monitoring targets.
(two) medical assistance standards for different security objects
1, proportion of outpatient assistance: for diseases eligible for outpatient assistance, assistance shall be given according to 10% of outpatient medical expenses within the annual limit, with the maximum annual assistance limit of 5,000 yuan;
2. Proportion of hospitalization assistance: the minimum living security objects, poverty alleviation policies and key monitoring objects shall be given assistance within the annual assistance limit of not less than 70%, and the annual maximum assistance limit is 6,543,800 yuan; The proportion of poor support personnel who are supported dispersedly shall be no less than 80% within the annual relief limit, and the proportion of poor support personnel who are supported centrally shall be no less than 90% within the annual relief limit. The annual maximum relief limit is 6,543,800 yuan.