1. Who can participate in Taizhou Limin Insurance?

A: There is no age, gender, occupation, medical history and other restrictions on participating in Taizhou Limin Insurance. Anyone who has paid the basic medical insurance in Taizhou (including urban workers and urban and rural residents) and is in the insured state can participate in the insurance independently.

2. How much is "Taizhou Limin Insurance"?

A: In 2023, the premium standard of "Taizhou Limin Insurance" will be 100 yuan/person, and the minor 60 yuan/person (all insured persons will be eligible for insurance after 2005 1). After that, under the guidance of the Municipal Medical Insurance Bureau, appropriate adjustments will be made according to the actual operation of the project.

3. If I am insured with "Taizhou Limin Insurance", what expenses can I reimburse?

A: The coverage of "Taizhou Limin Insurance" is connected with the basic medical insurance, and the medical expenses of the insured must be reimbursed by the basic medical insurance before they can be included in the protection. If the main operation or treatment of the insured in this hospitalization is not included in the medical service list of the basic medical insurance in Zhejiang Province, then the medical expenses incurred in this hospitalization will not be reimbursed by the basic medical insurance, and you will not be able to enjoy the reimbursement of Taizhou Limin Insurance.

The scope mainly includes four aspects:

(1) Responsibility 1: Personal expenses in the medical insurance catalogue. During the guarantee period, the medical expenses paid by the serious illness insurance fund of the insured in the designated medical institutions for medical insurance, and the remaining expenses after medical insurance reimbursement (including various funds).

(2) Responsibility 2: Reasonable expenses not included in medical insurance reimbursement. During the guarantee period, the insured's reasonable self-funded drugs (within the limited catalogue 1860), medical services beyond the limited payment scope (excluding rehabilitation projects and other non-disease treatment projects under the code of 3402) and self-funded medical materials required to meet the clinical treatment standards. The expenses of the above responsibilities occurred in the hospital during the hospitalization of the designated medical institutions of medical insurance, excluding outpatient and off-campus purchases. (For medical treatment in designated medical institutions outside Taizhou, the expenses incurred in this responsibility are included in this responsibility at 50%. )

(3) Responsibility 3: During the guarantee period, the insured shall prescribe innovative drugs (excluding out-of-hospital purchases) in designated medical institutions with secondary and tertiary medical insurance according to regulations, or after seeing a doctor in designated medical institutions with secondary and tertiary medical insurance according to relevant results such as disease diagnosis, pathological report and genetic testing, the list of 35 innovative drugs and 3 rare drugs with the above responsibilities must meet the indications listed in the list.

(4) Responsibility 4: During the guarantee period, the reasonable medical expenses incurred by the insured in medical institutions designated by medical insurance and outpatient hospitals for special diseases that meet the requirements of clinical treatment will be reimbursed by medical insurance (including various funds) and Taizhou Limin Insurance (responsibilities 1, 2 and 3), and the remaining individuals will pay part of the expenses in cash. (1. Limited to insured persons who have been insured for two consecutive years or more. 2. Those who are insured for the first time in 2023 shall be deemed to have been insured for two consecutive years. )

Description:

(1) Responsibility 4 Reasonable medical expenses refer to the medical expenses within the reimbursement scope of basic medical insurance and limin insurance, which are determined by medical insurance and hospital experts.

② In the 2023 edition, according to the principle of "long-term overpayment and overpayment", the reimbursement ratio of the insured who continues to participate in the insurance will be increased, and the four-responsibility guarantee will be increased. Those who are insured for the first time in 2023 (the treatment period is 2023) shall be deemed to have been insured for two consecutive years. Specifically: (1) Responsibility II, Responsibility III. For those who have been insured for two consecutive years, the basic compensation ratio will increase by 2%, for those who have been insured for three consecutive years, the basic compensation ratio will increase by 5%, and those who have been insured intermittently (for the first time or intermittently) will enjoy treatment according to the basic compensation ratio; (2) The insured who has been insured for two years or more in a row can enjoy Liability IV.

(3) Responsibility II and Responsibility III Establish a positive list of drugs, with 38 kinds of responsibility II 1860 and responsibility III.

(4) Hospitalization expenses of medical institutions: expenses listed in invoices and lists issued by medical institutions.

4. What is the reimbursement rate of Taizhou Limin Insurance?

A:

The liability deductible line is the same as the critical illness deductible line of 20,000 yuan (the part above the critical illness insurance deductible line is free of compensation), and the part above the deductible line is reimbursed according to the proportion of 55%, and the annual cumulative maximum payment limit is 6,543,800 yuan.

The deductible line of liability II is 1 0,000 yuan, 35% of which is partially reimbursed 1 0,000-0.5 million yuan, 50% of which is partially reimbursed 0.5-30,000 yuan, and 70% of which is partially reimbursed 30,000 yuan or more (the proportion of customers who renew their insurance for two consecutive years is increased by 2%), and the annual cumulative maximum compensation limit is/kloc.

The deductible for liability III is 6,543,800 yuan, and the part above the deductible is reimbursed by 50% (the proportion of customers who renew their insurance for two consecutive years increases by 2%), and the annual cumulative maximum compensation limit is 6,543,800 yuan (the annual cumulative compensation limit for rare drugs is 6,543,800 yuan).

Compensation for four liabilities: 6,543,800 yuan, and the proportion of compensation: 6,543,800+200,000-200,000, 200,000-300,000, 300,000-400,000, 40,000-500,000, 50% (6,543,800+). The annual cumulative maximum compensation limit is 6,543,800.

Description:

(1) Responsibility IV Reasonable medical expenses refer to medical expenses within the reimbursement scope of basic medical insurance and "Taizhou Limin Insurance", which are determined by medical insurance and hospital experts in the first instance.

(2) In the 2023 edition, according to the principle of "long-term overpayment", the reimbursement ratio of those who continue to participate in the insurance was increased, and the four-liability guarantee was added. Those who participate in insurance for the first time in 2023 (the treatment period is 2023) are deemed to have participated in insurance for two consecutive years. Specifically: (1) For those who have been insured for two consecutive years, the basic compensation ratio will increase by 2% for three consecutive years, and that for those who have been insured for three consecutive years will increase by 5%. Those who have been insured intermittently (for the first time or intermittently) will enjoy treatment according to the basic compensation ratio; (2) The insured who has been insured for two years or more in a row can enjoy Liability IV.

(3) Responsibility II and Responsibility III Establish a positive list of drugs, with 38 kinds of responsibility II 1860 and responsibility III.

(4) Expenses incurred by medical institutions in hospital: expenses listed in invoices and lists issued by medical institutions.