Hubei Province, the starting standard of medical treatment for major illnesses upward annual maximum payment limit of not less than 300,000 yuan
November 7, the provincial government office yesterday issued a "notice on the further improvement of urban and rural residents of the work of major medical insurance", the province's major medical treatment starting standard up to 12,000 yuan, the participants reimbursement is also adjusted to the maximum of one year not less than 300,000 yuan, the new standard from January 1 next year The new standard will be implemented from January 1 next year.
It is reported that in 2013, the province promulgated the "implementation plan for urban and rural residents of Hubei Province," the implementation of the work of major medical insurance (for trial implementation), the starting standard is set at 8,000 yuan, yesterday's new notice on the reimbursement rate, the scope of coverage and so on have been adjusted.
The starting standard was adjusted to 12,000 yuan
The annual maximum payment limit is not less than 300,000 yuan
The notice issued yesterday by the province pointed out that the major medical insurance is the expansion and extension of the basic medical insurance system for urban and rural residents, is the high medical expenses incurred by patients with serious illnesses, a systematic arrangement to protect, can effectively alleviate the poverty due to illnesses, the problem of returning to poverty due to illnesses. The problem of returning to poverty due to illness can be effectively alleviated. In fact, as early as 2013, the province promulgated the "urban and rural residents of the implementation of the work of the implementation of major medical insurance program (for trial implementation)", in October of that year, Xianning City, opened the first major medical insurance reimbursement bill.
The notice released yesterday has many improvements compared to the 2013 implementation program, including the starting standard, reimbursement ratio, maximum amount, and the scope of participation.
The notice released yesterday pointed out that all the people who participated in the province's urban and rural residents of the basic health insurance, can be insured against major medical insurance, the conditions of the region, but also to participate in the basic health insurance for urban workers insured, into the scope of the major medical insurance, and not limited to the type of disease, hospitalization and outpatient treatment of special chronic illnesses, resulting in high medical costs, can be reimbursed.
According to the province's urban and rural disposable income per capita in the last three years and major medical expenses, the province's starting standard for major medical insurance is set at 12,000 yuan, but the notice also provides for the use of the starting standard period is until 2018.
At the same time, the notice also specifies the reimbursement in a segmented, proportional manner. The reporter noted that for the starting amount of reimbursement, the notice stipulates that it is calculated on a yearly basis, that is, the medical expenses incurred during an insurance year, the amount of personal burden is calculated cumulatively, reimbursed in segments, and settled in accordance with the time, and can only be deducted once a year.
The specific reimbursement rate is: the cumulative amount of 12,000 yuan more than 30,000 yuan (including) the following part of the reimbursement of 55%; 30,000 yuan more than 100,000 yuan (including) the following part of the reimbursement of 65%; 100,000 yuan more than the part of the reimbursement of 75%, the annual maximum payment limit of not less than 300,000 yuan in principle.
The implementation of municipal-level coordination of major medical insurance
Funds allocated from the basic health insurance fund
The notice requires the implementation of municipal-level coordination of major medical insurance in our province, to the city (state) as a unit of the implementation of the organization, by the commercial insurance institutions. Funding standards are determined by the city (state), the source of funds from the basic health insurance fund, residents do not pay a separate fee.
The implementation of the major disease insurance, to take the government to buy services, by commercial insurance organizations. Each city (state) through the government unified bidding, selected a commercial insurance institutions, a city (state) to undertake the major disease insurance commercial insurance institutions up to no more than two.
The premium income of commercial insurance institutions is exempted from business tax, insurance business supervision fees, and until 2018, exempted from insurance protection money on a trial basis. However, the profitability of commercial insurance institutions should be reasonably controlled, and the portion that exceeds the contractual agreement is fully returned to the city (state) big disease insurance fund. Due to policy reasons to commercial insurance institutions to bring losses, by the basic health insurance fund and commercial insurance institutions to share.
In addition, the localities should also establish the assessment deposit system, in the allocation of the cost of major disease insurance, set aside a certain percentage of the cost as the assessment deposit, the assessment of the unqualified to be deducted.