The first is the personal expenses and self-care expenses in the medical insurance catalogue. During the guarantee period, after the insured is hospitalized in the designated medical insurance hospital and treated in outpatient clinics for special diseases and chronic diseases, the medical expenses in the medical insurance catalogue will be reimbursed by basic medical insurance, critical illness and various kinds of assistance, and the part above the deductible line of critical illness insurance (20,000 yuan) can be reimbursed by 55%, with a maximum of 6,543.8+0,000 yuan a year.
Second, the reasonable expenses incurred during hospitalization that are not included in medical insurance reimbursement. During the guarantee period, the insured is hospitalized in the designated medical institution of medical insurance. For the out-of-pocket medical expenses paid out of and in the catalogue of 537 kinds of medical insurance, as well as the out-of-pocket medical services, medical materials or medical materials, if the out-of-pocket expenses exceed 5,000 yuan, 30% will be reimbursed for the part from 5,000 yuan to 30,000 yuan, 50% for the part exceeding 30,000 yuan (inclusive), and 60% at most within one year.
These 537 kinds of drugs cover all self-funded drugs used in major hospitals in counties and cities in Taizhou and drugs beyond the limited payment range in the medical insurance catalogue, which greatly expands the choice of drugs for patients and medical workers during hospitalization.
The third is the outsourcing cost of innovative drugs for specific tumors and critically ill patients. We all know that cancer and critically ill patients need some expensive drugs. In view of the situation of ordinary people, we organized experts to screen out 29 innovative drugs and 3 rare drugs according to the historical disease data of Taizhou people to be included in the reimbursement scope of "Taizhou Limin Insurance". The indications of these 32 drugs basically cover the high-risk population of tumor diseases in our city, and patients can buy them in the designated pharmacies that have opened one-card swipe cards in the city with prescriptions, as long as they exceed 654.38+00,000 yuan.
Main features:
First, it covers the whole people and has a high guarantee amount:
Nearly 6.5438+0.2 million people (including employee medical insurance and urban and rural medical insurance) who participated in the basic medical insurance in our city were all included in the scope of "Taizhou Limin Insurance". A person only needs to pay 100 a year, which is less than 30 cents a day on average, and can enjoy the maximum medical insurance quota of 3 million to ensure happiness for a whole year.
Second, the treatment is wide and the threshold for participation is zero:
"Taizhou limin insurance" is mainly to protect serious illness and serious illness. Treatment guarantee covers self-funded expenses beyond the reimbursement scope of basic medical insurance, including high-priced materials, high-priced drugs and innovative drugs for specific tumors and critical diseases that are not covered by some medical insurance. Moreover, this insurance does not set preconditions such as the insured's household registration, age, health status, past medical history and occupation type, and diseases can be reimbursed regardless of past or new occurrences. The reimbursement standard is the same.
Third, there are many ways to insure and settle claims quickly:
The insured can pay attention to the official WeChat account of "Taizhou Limin Insurance" or Alipay search for "Taizhou Limin Insurance" for online insurance, or can also apply for insurance through the QR code forwarded by employees of * * * insurance company. If it is stipulated that the medical expenses for outpatient and inpatient diseases are within the scope of diagnosis and treatment in Zhejiang Province, the "one-stop" claim can be realized through the medical insurance information system, and there is no need to apply for claims from insurance companies, which effectively solves the problem of "expensive medical treatment and expensive errands" for the insured people.
Fourth, there are payment support and difficult funding:
Employees who participate in medical insurance can use the balance of personal accounts over the years to buy for themselves or for family members (spouses, children, parents). Employers and urban and rural collective economic organizations can purchase commercial supplementary medical insurance for employees and residents, and the purchase funds are deducted before tax when calculating personal taxable income in accordance with the provisions of commercial health insurance. At the same time, for the needy people in our city who are included in the poverty-stricken, low-income and low-income, the existing policy-based commercial supplementary medical insurance for poverty alleviation will be integrated and insured by the municipal financial subsidy.