165438+1On October 7, the general office of the provincial government issued the Notice on Further Improving the Work of Serious Illness Insurance for Urban and Rural Residents yesterday, which raised the threshold for medical treatment for serious illness in our province to1.20 thousand yuan, and adjusted the reimbursement amount of the insured to a maximum of not less than 300 thousand yuan a year. The new standard will be implemented from 65438+ 10/month next year.
It is reported that in 20 13, our province issued the "Implementation Plan of Serious Illness Insurance for Urban and Rural Residents in Hubei Province (Trial)", with a minimum threshold of 8,000 yuan. The newly issued notice yesterday adjusted the reimbursement ratio and insurance coverage.
Qifubiaozhun increased to 6.5438+0.2 million yuan.
The annual maximum payment limit is not less than 300,000 yuan.
The notice issued by our province yesterday pointed out that the serious illness insurance is the expansion and extension of the basic medical security system for urban and rural residents, and it is an institutional arrangement to ensure the high medical expenses of seriously ill patients, which can effectively alleviate the problems of poverty caused by illness and returning to poverty due to illness. In fact, as early as 20 13, our province promulgated the Implementation Plan of Serious Illness Insurance for Urban and Rural Residents (Trial), and in June of that year, Xianning City issued the first reimbursement form of serious illness insurance.
Compared with the implementation of 20 13, the notice issued yesterday has many improvements, including the minimum payment standard, reimbursement ratio, maximum amount, insurance coverage and so on.
The notice issued yesterday pointed out that anyone who participates in the basic medical insurance for urban and rural residents in our province can apply for serious illness insurance. Conditional areas, but also to participate in the basic medical insurance for urban workers into the scope of serious illness insurance, not limited to diseases, special chronic disease hospitalization and outpatient treatment, has caused high medical expenses, can be reimbursed.
According to the per capita disposable income and medical expenses of urban and rural residents in the province in the past three years, the threshold of serious illness insurance in the province was set at10.2 million yuan, but the notice also stipulated that the service life of the threshold was 20 18.
At the same time, the notice also made it clear that reimbursement should be made in a segmented and proportional manner. The reporter noticed that the deductible for reimbursement is calculated on an annual basis, that is, the medical expenses incurred in an insurance year, the personal burden amount accumulated, reimbursed by stages, and settled by time, and can only be deducted once a year.
The specific reimbursement ratio is: 55% of the accumulated amount 1.2 million yuan but not more than 30,000 yuan (inclusive); 65% for reimbursement from RMB 30,000 to RMB 6.5438+RMB 10,000 (inclusive); 65438+ 75% will be reimbursed for the part above 10,000 yuan, and the maximum annual payment limit is not less than 300,000 yuan in principle.
Serious illness insurance shall be co-ordinated at the municipal level.
Funds are allocated from the basic medical insurance fund.
The notice requires that the major illness insurance in our province should be coordinated at the city (state) level, organized and implemented by the city (state) as a unit, and undertaken by commercial insurance institutions. The financing standard is determined by each city (state), and the source of funds is allocated from the basic medical insurance fund, and residents do not have to pay separately.
The major illness insurance implemented this time takes the form of services purchased by the government and is borne by commercial insurance institutions. Each city (state) chooses a commercial insurance institution through unified government bidding, and no more than two commercial insurance institutions undertake serious illness insurance in one city (state).
The premium income of commercial insurance institutions can be exempted from business tax and insurance business supervision fee, and the insurance guarantee fund is exempted from trial 20 18. However, it is necessary to reasonably control the profitability of commercial insurance institutions and return all the parts beyond the contract to the city (state) serious illness insurance fund. Losses caused to commercial insurance institutions due to policy reasons shall be shared by the basic medical insurance fund and commercial insurance institutions.
In addition, all localities should also establish an assessment deposit system. When sharing the cost of serious illness insurance, a certain proportion of the cost should be reserved as the assessment deposit, and those who fail the assessment should be deducted.