Detailed Rules for the Implementation of Medical Insurance and Assistance System for Serious and Serious Diseases in Meishan City

Chapter 1? Total? Then

the first one? In order to further reduce the burden of medical expenses for poor workers and urban and rural residents, prevent the risk of returning to poverty due to illness, and build the bottom line of people's livelihood security, according to the spirit of the Opinions of the General Office of the State Council on Improving the Medical Insurance and Assistance System for Serious and Extraordinary Diseases (Guo Ban Fa [221] No.42) and the Implementation Opinions of the General Office of Sichuan Provincial People's Government on Improving the Medical Insurance and Assistance System for Serious and Extraordinary Diseases (Chuan Ban Gui [222] No.6), combined with the actual situation of our city,

article 2? The medical insurance and assistance system for serious and serious diseases follows the following principles:

(1) Adhere to the principle of ensuring all the insurance, ensuring the basics, doing our best and doing what we can, and the level of assistance is compatible with economic and social development.

(2) strengthen the comprehensive guarantee of basic medical insurance, serious illness insurance and medical assistance (hereinafter referred to as the triple system), focus on reducing the burden of medical expenses for employees with difficulties and urban and rural residents with serious diseases, form a joint force of systems, and realize efficient linkage and benign interaction.

(3) Establish a unified medical assistance system in the whole city, and fully realize the overall planning of medical assistance at the municipal level. The city's unified rescue scope, unified funding, unified rescue methods, unified rescue standards, unified fund management, and unified settlement methods.

(4) Optimize the rescue process, standardize the settlement procedures, and realize the "one-stop" and "one-order" settlement of medical assistance with basic medical insurance, serious illness insurance, various supplementary medical insurance and commercial health insurance, so as to ensure timely and effective assistance for employees in need and urban and rural residents.

article 3? The Municipal Medical Security Bureau is the competent department of medical assistance in the whole city, and the Social Affairs Bureau of Meishan Administrative Committee of Tianfu New District and the County (District) Medical Security Bureau are the competent departments of medical assistance in this area. City, county (District) two levels of medical security agencies in accordance with the division of responsibilities to do a good job in business handling.

chapter 2? Object of assistance and identification

Article 4? The target of assistance. Medical assistance fairly covers employees and urban and rural residents with heavy medical expenses, and classified assistance is implemented according to the categories of recipients.

(1) extremely poor people;

(2) orphans;

(3) low-income objects;

(4) marginal family members;

(5) the rural people who are easy to return to poverty and lead to poverty under the monitoring scope (hereinafter referred to as the monitoring object for preventing return to poverty);

(6) seriously ill patients (hereinafter referred to as poverty-stricken seriously ill patients due to illness) who do not meet the conditions of poor people's assistance and support, low-income or low-income marginal families, but have serious difficulties in family basic life due to high medical expenses.

other people with special difficulties specified by the local people's governments at or above the county level shall be given corresponding assistance according to the above categories of assistance objects.

article 5? Poor people, orphans, subsistence allowances, marginal family members and seriously ill patients suffering from poverty due to illness are identified by the civil affairs department, and the monitoring objects for preventing poverty return are identified by the rural revitalization department.

chapter 3? Methods and standards of assistance

Article 6? Classified funding for insurance

After participating in the basic medical insurance according to law, people with difficulties enjoy the rights and interests guaranteed by the triple system according to regulations. For people in difficulty who have achieved stable employment, guide them to participate in basic medical insurance for employees according to laws and regulations. We will fully implement the financial subsidy policy for urban and rural residents' basic medical insurance. For the individual contributions to participate in the basic medical insurance for urban and rural residents, the destitute and orphans will be fully funded, and the minimum living allowance and the monitoring objects to prevent poverty will be given a fixed subsidy of 75%. The specific funding standards are announced by the Municipal Medical Security Bureau in the annual payment period of urban and rural residents' centralized insurance.

article 7? Medical expenses assistance

(1) the scope of assistance expenses protection. Strictly implement the medical insurance treatment list system.

The drugs, medical consumables and diagnosis and treatment items paid by the medical assistance fund shall comply with the provisions of the basic medical insurance payment scope. The assistance expenses mainly cover the hospitalization expenses incurred by the aid recipients in the designated medical institutions, the expenses of long-term outpatient treatment due to chronic diseases or serious diseases, and the expenses of single-line payment of drugs and high-value drugs. Personal out-of-pocket expenses within the policy scope below the deductible line of basic medical insurance and serious illness insurance shall be included in the rescue guarantee according to regulations. Unless otherwise specified by the state and province, the scope of medical assistance expenses shall not be expanded by itself or by flexible methods.

(2) Qifubiaozhun for assistance. According to the family difficulties of the relief object, the annual relief Qifubiaozhun (hereinafter referred to as Qifubiaozhun) is set according to the classification.

1. the qifubiaozhun is completely abolished for the destitute, orphans and low-income recipients;

2. Qifubiaozhun for monitoring objects to prevent poverty return is determined according to 5% of the per capita disposable income of residents in our city last year;

3. The minimum threshold for marginal family members is determined by 1% of the per capita disposable income of residents in our city last year;

4. Qifubiaozhun for poor and seriously ill patients due to illness is determined according to 25% of the per capita disposable income of residents in our city last year.

co-ordinate outpatient chronic diseases, outpatient serious and serious diseases (hereinafter referred to as outpatient chronic and special diseases) and hospitalization assistance, and calculate the threshold for outpatient chronic and special diseases and hospitalization medical expenses, and * * * use the annual assistance limit. The annual specific relief Qifubiaozhun was announced by the Municipal Medical Security Bureau.

(3) the proportion and limit of assistance. If the medical expenses paid by individuals exceed Qifubiaozhun within the scope of the assistance target policy, assistance shall be provided in proportion within the annual assistance limit.

1. Give full assistance to the destitute and orphans, and there is no annual assistance limit;

2. 7% of the minimum living allowance recipients will receive assistance, with an annual assistance limit of 4, yuan;

3. 65% of the monitored objects to prevent returning to poverty will be assisted, with an annual assistance limit of 3, yuan;

4. 5% of the marginal family members and patients suffering from poverty and serious illness due to illness are assisted, and the annual assistance limit is 2, yuan.

(4) Inclined rescue. To standardize the referral and seek medical treatment in the province, after the comprehensive guarantee of the triple system, the accumulated annual out-of-pocket expenses of individuals within the policy scope still exceed the income standard of the city to prevent poverty, and the proportion of assistance is 5%, and the annual assistance limit is 2, yuan.

article 8? The object of assistance with multiple special identity attributes shall be included in the scope of assistance according to the principle of "high is not low" and shall not be rescued repeatedly.

article 9? Qifubiaozhun for medical expenses assistance, proportion and annual assistance limit can be dynamically adjusted by the Municipal Medical Security Bureau according to the level of economic and social development, people's health needs and the support capacity of medical assistance funds.