The New Deal of Hubei Medical Insurance will be implemented on September 1st, and four types of personnel can receive medical assistance

The 21st Century Business Herald reporter Liu Qian intern Shu Yunhan reported in Wuhan Recently, the General Office of the People's Government of Hubei Province issued the "Implementation Opinions on Implementation of Medical Insurance and Rescue System of Healthy Diseases" and "Implementation Opinions on Comprehensive Practice Basic Medical Insurance City "Two major reforms.

Among them, the "Implementation Opinions on Implementation of Medical Insurance and Rescue System for Heavy Diseases" clarified the scope of the four types of rescue objects, and the policy was implemented from September 1 this year. The "Implementation Opinions on the Comprehensive and Practical Basic Medical Insurance Municipal -level Coordination" pointed out that by the end of 2022, Hubei comprehensively implemented the city -level coordination of basic medical insurance (including the overall planning of employees 'medical insurance and urban and rural residents' medical insurance. Insurance city -level overall planning is implemented simultaneously.

Implement layered classification rescue

The "Implementation Opinions on Implementing the Medical Insurance and Rescue System of Medical Diseases" divides various medical assistance objects into four categories, and implement layered category assistance.

One category includes urban and rural insights and orphans; the second category includes the lowest urban and rural living security objects, returning to the poor to the poor; the three types include members of the family members of urban and rural subsistence allowances. Three types of monitoring objects are prone to poverty and severe difficulties); four types of special difficulties stipulated by patients with poverty and serious illness due to illness and poverty -stricken diseases and local people's governments at or above the county level. The four categories are expenditure poverty -stricken rescue targets, which clarifies its identification standards. The poverty -stricken population and the rural areas that are included in the monitoring scope are prone to return to the poverty -stricken population during the transition period of poverty, and the implementation of the relevant policies of rural revitalization strategies in accordance with the results of consolidating and expanding the results of poverty alleviation.

What guarantees can medical assistance objects enjoy? According to the Hubei Provincial Medical Insurance Bureau, the above opinions are as follows:

Basic medical insurance subject protection. While implementing inclusive fiscal subsidies for participating residents, medical assistance objects such as special poverty, subsistence allowances, and poverty -stricken people will be used to participate in the insurance. One type of object is funded at a percentage of personal payment at a ratio of 100 %; the second -class object will be funded at the proportion of individual payment at a ratio of not less than 90 %. The rural areas that are incorporated into the scope of monitoring will be funded by individual payment during the transitional period of poverty -poverty and poverty.

Replenishing protection for major illness insurance. The annual personal payment medical expenses exceeded the starting payment standard of 12,000 yuan, which was included in the insurance insurance. The execution of the first and second objects of major illness insurance is reduced by 50 %, the reimbursement ratio is increased by 5 %, and the tilt payment policy for canceling the top line is canceled.

Medical assistance bottom guarantee. Inpatient expenses incurred in designated pharmaceutical institutions, the cost of long -term medication for chronic diseases, and the cost of long -term outpatient treatment for severe diseases needed for severe diseases. Scope of medical assistance guarantee. Eligible outpatient clinics have paid medical expenses within the scope of slow special disease policies, and each city (state) is rescued at a proportion of not less than 50 %. Among the inpatient medical assistance, the first and second objects, there is no standard for payment, and the personal expenses of individuals within their policy scope will be rescued at 100 % and no less than 70 %; The standards are determined by about 10 % and 25 % of the per capita disposable income of residents in each city (state) of each year, and the proportion of individuals' medical expenses within the scope of their policies will be rescued at no less than 60 % and 50 %, respectively.

Annual medical assistance limit. Outpatient medical assistance and hospitalization medical assistance sharing an annual medical assistance limit. Specific medical assistance starting standards, rescue ratio and rescue limit are determined by the people's governments of each city (state).

Key measures. After the medical assistance target that regulates referrals and medical treatment in the province, after comprehensive guarantee for the triple system (basic medical insurance, major illness insurance, medical assistance), the medical expenses within the scope of the policy exceed the 25 % of the per capita disposable income of the local residents' per capita residents within the scope of the policy. And those who return to the risk of poverty to poverty are given tilt assistance at a ratio of not less than 50 %.

Comprehensively do basic medical insurance city -level overall planning

Regarding the "Implementation Opinions on Comprehensive and Practical Insurance Municipal -level Coordination", the Hubei Provincial Medical Security Bureau stated that comprehensively doing basic medical insurance city -level overall planning not only follows the development rules of the medical insurance system, but also balances the treatment of the coordinated region. The level is of great significance for improving the modernization of the medical insurance governance system and governance capacity, and establishing a more fair and sustainable medical security system.

The above opinions have clearly made the "six unification" tasks of the city level comprehensively doing basic medical insurance.

The first is the unified policy and system. In the municipal (state) overall planning area, the policy and systems such as medical insurance and urban and rural residents' medical insurance participation insurance payment, fundraising standards, and treatment payment are unified.

The second is unified treatment standards. Strictly implement the national unified pharmaceutical directory and the province's unified diagnosis and treatment items, scope of medical service facilities and payment standards for payment. In the municipal (state) overall planning area, uniformly uniformly paid -in -payment standards, payment ratios, and maximum payment limit for medical expenses within the scope of policy scope of ordinary outpatient clinics, outpatient clinics, and hospitalization.

The third is unified fund management. The basic medical insurance fund implements the unified collection of municipal (state), and is included in the management of municipal (state) fiscal households, and the two lines of income and expenditure are implemented. The employee medical insurance fund and the urban and rural residents' medical insurance funds are separated, accounts for accounting, and special funds.

The fourth is unified service.Each city (state) implements a unified business work process such as insurance registration, payment declaration, treatment payment, medical management, and expense settlement, and provides convenient and efficient service services for participants.The fifth is to manage certain points.Each city (state) formulates a unified management measures and agreement texts of designated pharmaceutical institutions, strengthen supervision of the performance of the agreement, establish and improve the mechanism for evaluation and evaluation and dynamic access to exit, and severely crack down on fraud.

Sixth is the construction of unified information system.Relying on the province's medical insurance information platform, the management of the management is uniformly regulated, and the "one -stop" real -time settlement is achieved.Carry out the new service model of "Internet+Medical Insurance Payment" to promote the equal reach of public services in medical security.

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