Notice of work implementation plan
Town People's Government (street office):
The "Implementation Plan for the" Qin "Work of Pubei County's Inclusive Commercial Health Insurance" has been approved by the county people's government and is hereby issued to you. Please earnestly organize the implementation.
Pubei county medical treatment security bureau Pubei county bureau of finance
65438+February 2022
Pubei County Pratt & Whitney Commercial Health Insurance "Qin"
Work implementation plan
According to the Notice of Guangxi Zhuang Autonomous Region Committee and People's Government of Guangxi Zhuang Autonomous Region on Printing and Distributing the Implementation Opinions on Deepening the Reform of Medical Security System (Zheng Gui [2020]18) and the Notice of Guangxi Construction Finance Open Portal Command on Printing and Distributing the Reform and Innovation Task List of Insurance Innovation Comprehensive Experimental Zone (Zheng Gui [2023] No.7) and the Qinzhou Supervision Branch of Qinzhou Medical Insurance Bureau, Qinzhou Finance Bureau, Notice of the Insurance Regulatory Commission of the Bank of China on Printing and Distributing the Implementation Plan of Qinzhou Inclusive Commercial Health Insurance (Qin Medical Insurance [2022] No.68), in order to build and improve the multi-level medical security system in our county, promote the integrated development of medical insurance and commercial health insurance, and promote the establishment of a unified localized inclusive commercial health insurance system in the county, and improve the level of medical security as a whole, the inclusive commercial health insurance system in our county (hereinafter referred to as "Qin") is now established in combination with the actual situation in our county.
I. Guiding ideology
Guided by Xi Jinping Jinping's Socialism with Chinese characteristics Thought in the New Era, we will thoroughly implement the Central Committee of the Communist Party of China's opinions on deepening the reform of the medical security system, adhere to the people's health as the center, and establish a broad-coverage, broad-coverage, cohesive, healthy, sustainable and stable commercial health insurance system on the basis of China's basic medical insurance system to promote development. Effectively solve the problem of "poverty caused by illness and returning to poverty due to illness", strive to reduce the economic burden of serious illness of the masses, and continuously enhance the sense of happiness, acquisition and security of the masses.
Second, the basic principles
(A) government guidance, social management * * *
The government actively promotes universal health supplementary medical insurance, guides and promotes the integrated development of social medical insurance and commercial health insurance, establishes a multi-level medical security system, meets the diverse security needs of the people, and further improves the medical security level of the insured.
(2) Wide coverage and simple investment and compensation.
Insured persons of basic medical insurance for workers in Pubei County and basic medical insurance for urban and rural residents can voluntarily choose to buy "Qin Bao Hui" without any restrictions such as age, household registration, health status, past medical history, occupation type and disease risk. Low starting premium, no pressure for ordinary policyholders to buy, online insurance, one-stop claim settlement, convenient and efficient.
(3) Public welfare orientation, with low profit guaranteed.
"Qin" is undertaken by the selected commercial insurance institutions. The organizer should take the market mechanism as the guide, ensure low cost and low profit, and highlight public welfare. The premiums raised are mainly used for the payment expenses of the insured, and they are responsible for their own profits and losses and risks. Establish a dynamic adjustment mechanism, rationally adjust the premium standard and guarantee content, and ensure the sustainability of the project.
(4) Policy inclination to help rural revitalization.
Preferential policies are implemented for people with special difficulties (especially poor people, orphans, children who are actually neglected, low-income objects with minimum living allowances and low-income objects within the validity period). Encourage employers to buy Qin for employees, urban and rural collective economic organizations, residents, charitable people and people with special difficulties.
Third, the main content
Financing mechanism
According to our county's economic and social development level, basic medical security treatment level, security needs and insurance coverage and other factors, scientifically determine the payment standard.
1. premium standard: in principle, the annual premium standard of "Qin" is determined according to about 0.3% of the per capita disposable income of Qinzhou last year, and the premium standard of "Qin" in 2022-2023 is 79 yuan per person per year. Specific standards can be dynamically adjusted once a year. Commercial insurance institutions will calculate the security demand, fund balance and other factors, and report to the "Qin" work leading group for determination.
2. Premium payment: Insured persons can pay their own purchase expenses through online and offline channels. The insurance period of Qin is 1 year, and 1-2 months is selected as the centralized payment period every year. The insured shall complete the payment before the deadline for centralized payment.
(2) The object and scope of protection
1. The object of protection is the employees of our county and the participants of basic medical insurance for urban and rural residents, regardless of age, household registration, health status, past medical history, occupational type and disease risk.
2. The scope of protection is connected with the basic medical insurance for employees, large-scale medical co-ordination, civil servants' Medicaid and large-scale medical secondary reimbursement, and with the basic medical insurance for urban and rural residents, serious illness insurance for urban and rural residents and medical assistance. And guarantee the following expenses:
(1) Out of your own pocket. Urban workers insured in line with the scope of reimbursement of basic medical insurance medical insurance designated medical institutions during hospitalization, by the basic medical insurance, Medicaid for civil servants, large medical expenses as a whole and large medical expenses for the second reimbursement of out-of-pocket expenses; Urban and rural residents insured in line with the basic medical insurance reimbursement scope of medical insurance designated medical institutions during hospitalization, by the basic medical insurance, serious illness insurance and medical assistance reimbursement of out-of-pocket expenses.
(2) Self-funded drug expenses. Compliance and self-funded drug expenses incurred by the insured during hospitalization in designated medical institutions of medical insurance (referring to drug expenses that meet the indications of drug instructions, drug expenses beyond the limited scope in the medical insurance catalogue and drug expenses outside the medical insurance catalogue).
(3) Protection level
According to the level of medical security treatment in our county, the security needs of the insured and the insurance premium rate, the security level is set reasonably.
1. deductible line: the deductible line for urban workers is 1 10,000 yuan, and the deductible line for urban and rural residents is10.5 million yuan.
2. Payment proportion:
(1) The out-of-pocket ratio of designated medical institutions in the city (including Beihai, Fangchenggang, Yulin and Chongzuo) is 50%, and that of designated medical institutions outside the city is 40%.
(2) The proportion of self-funded drug expenses incurred during hospitalization in designated medical institutions is 30%.
3. Compensation limit: the maximum out-of-pocket compensation amount in the insurance year is 6,543,800 yuan; The maximum amount of self-funded drug expenses is 6,543,800 yuan.
(4) Payment period and insurance period
The payment time of Qin is from June 10 to February 12 every year, and the insurance period is from 0: 00 on February 3 1 day of that year to 24: 00 on February 30 of the following year, with a term of one year. In 2022, the insurance payment time is from 2022 1 1.2 to 2022 1.2.