Subsidizing the impoverished population to participate in medical insurance for urban and rural residents, implementing outpatient services and lowering the initial payment standard of major diseases insurance for rural impoverished population from 12,000 to 5,000... On July 10th, it was informed from the Social Assistance Bureau that Yichang Civil Affairs Bureau, Yichang Finance Bureau, Yichang Human Resources and Social Security Bureau, Yichang Commission of Health and Health Planning, the Office of Hubei Provincial Poverty Alleviation and Development and six Departments of Yichang Insurance Regulatory Commission jointly issued the Implementation Plan for Further Strengthening the Effective Connection between Medical Aids and the Serious Diseases Insurance for Urban and Rural Residents(hereafter referred to as the Implementation Plan) in which they declared to conduct medical aids for major and serious diseases to such people as specially poor support objects, orphans, urban and rural subsistence allowances objects, impoverished population who have already registered for a card, low-income urban recipients, sick patients with poor family due to illness and other persons with special difficulties specified by the people's governments at or above the county level.
In the meantime, after Yichang built and carried out four-in-one healthy poverty alleviation mode of Basic Medical Insurance + Critical Diseases Insurance + Medical Aids + Supplementary Insurance, the individual actual reimbursement ratio of hospitalization expenses for rural impoverished population reached about 90%.
Subsidizing people with difficulties to participate in medical insurance for urban and rural residents
The Civil Affairs Department is in charge of identifying and implementing Insured Individual Contribution Funding Policy among people with difficulties such as specially poor support objects, orphans, urban and rural subsistence allowances objects, The Civil Affairs Department is also in charge of identification of aged people over 60 years old and juveniles from low-income urban households while the Financial Department arranges quota funded insurance funds from the budget. The Poverty Alleviation Department takes charge of the identities of impoverished population who have already registered for a card of targeted poverty alleviation and after that the county (city, district) government implements insured individual contribution support policy for impoverished population.
Carrying out outpatient aids
Beside carrying out outpatient aids for specially poor support objects, orphans, urban and rural subsistence allowances objects and impoverished population who have already registered for a card, qualified counties(cities, districts)can also enlarge the scope to low-income urban recipients(namely, old people, juveniles, seriously ill or severely disabled objects in low-income urban households).
According to application acceptance, all local organs can grant quota outpatient aids of no more than 1000 yuan to those outpatient aids objects who have developed chronic diseases and have to rely on perennial drug treatment or subsistence but have difficulties in purchasing drugs.
Implementing Medical Aids for Major and Serious Diseases for Seven Kinds of People
Medical aids for major and serious diseases will be carried out to specially poor support objects, orphans, urban and rural subsistence allowances objects and impoverished population who have already registered for a card, low-income urban recipients, sick patients with poor family due to illness and other persons with special difficulties specified by the people's governments at or above the county level.
For the part of annual cumulative self-paid compliance medical expenses for aids objects receiving inpatient treatment over major illness insurance initial payment standard, aids will be granted according to the following radios after major illness insurance reimbursement:
Full aids will be offered to specially supported poor objects or orphans; 70% aids will be offered to urban and rural subsistence allowances; for medical expenses below 30,000 yuan, no less than 50% aids will be granted to impoverished population who have already registered for a card and low-income urban aids recipients, and for medical expenses over 30,000 yuan no less than 60% aids will be offered; sick patients with poor family due to illness and other persons with special difficulties will be offered no less than 30% aids with the medical expenses over 30,000 yuan but below 50,000(included) and be offered no less than 40% aids when medical expenses are below 50,000 yuan.
In principle, annual maximum aids limit on medical aids for major and serious diseases are supposed to be no less than 80,000 yuan. Qualified counties (cities, districts) can grant aids object compliance medical expenses according to self-paid expenses except medical aids object compliance medical expenses according to a certain ratio.
Improving major diseases insurance treatment for rural impoverished population
Major diseases insurance initial payment standard for rural impoverished population has been lowered from 12,000 yuan to 5,000 yuan.
Within an insurance year, the standard initial payment standard for major diseases insurance can only be deducted for once: 60% of the accumulated amount of major diseases insurance for the impoverished population will be reimbursed for the part over initial payment standard to the part below 30,000(included) yuan; 70% will be reimbursed for the part over 30,000 yuan to the part below 100,000 yuan (included) and 80% will be reimbursed for the part over 100,000 yuan.
Within an insurance year, self-paid amount within insurance coverage for major diseases has three kinds of modes, namely, accumulative calculation, subsection reimbursement, settlement by time. It is not permitted to calculate the accumulated individual paid amount of major diseases insurance by offsetting it with medical aids amount enjoyed by impoverished population in the past years and other leaning treatment.
Annual maximum amount of payment of major diseases insurance for impoverished population is no less than 350,000 yuan.
And the annual individual actual paid medical expenses for rural impoverished population are no more than 5,000 yuan.
After Yichang built and carried out four-in-one healthy poverty alleviation mode of Basic Medical Insurance + Critical Illness Insurance + Medical Aids + Supplementary Insurance, the personal actual reimbursement ratio of hospitalization expenses for rural impoverished population reached about 90%, the ratio of outpatient medical expenses for major diseases and special chronic diseases reached 80% and the annual individual actual paid medical expenses are controlled within 5,000 yuan.
In combination with self reality, qualified counties (cities, districts) can include themselves in the scope of four-in-one health poverty alleviation policy on the basis of implementing medical insurance policy prevailing in provinces and cities for objects like rural subsistence allowances recipients, people of rural extreme poverty and rural orphans.
People with difficulties inside the county-level administrative regions are allowed to pay the medical expenses after treatment.
For specially poor support objects, orphans, urban and rural subsistence allowances objects and impoverished population who have already registered for a card, low-income urban recipients, policy of payment after treatment will be comprehensively implemented for hospitalization in designated medical institutions in the county and establishment of settlement mechanism of payment after treatment will be advanced within the city-level administration regions to conduct graded referrals and medical treatment in different places among people with difficulties. In principle, medical insurance designated medical institutions responsible for regional public health services can be ratified as medical aids designated medical institutions. Patients should go to doctors in the local designated medical institutions. If they go to non-designated medical institutions or designated medical institutions outside the county, they ought to perform the stipulations to report for approval before implementation. (Reporter Xiao Min, correspondent Wang Chunli, intern Zhao Xiaorong)