At present, the medical insurance of residents in our province has achieved comprehensive planning at the municipal level, and the insured residents in the city enjoy the same medical insurance treatment. It mainly includes general outpatient treatment, "two diseases" outpatient medication guarantee treatment, outpatient chronic disease and special disease treatment and hospitalization treatment. People who participate in medical insurance for urban and rural residents participate in major illness insurance simultaneously, and individuals do not have to pay extra.
General outpatient treatment
It mainly pays for outpatient treatment in township hospitals, village clinics and other grassroots medical and health institutions. The proportion of medical expenses paid within the scope of general outpatient service policy is not less than 50% in principle. In 2023, the overall payment limit for general out-patient clinics in all localities shall not be lower than that in 350 yuan, which shall be subject to local policies.
Drug guarantee treatment for outpatients with hypertension and diabetes.
Relying on secondary and below designated primary medical institutions, for patients with chronic diseases and special diseases who are not included in the outpatient coverage but need to be treated with antihypertensive and hypoglycemic drugs, antihypertensive and hypoglycemic drugs will be included in the outpatient coverage, and the payment ratio within the policy scope will reach more than 50%. At present, some areas in the province have widened the designated medical institutions for "two diseases" to qualified secondary and above medical institutions.
Treatment of chronic and special diseases in outpatient department
The chronic diseases in provincial outpatient service include 14, specifically, radiotherapy and chemotherapy for malignant tumor outpatient service, dialysis for chronic renal failure, anti-rejection treatment for outpatient service after organ transplantation, systemic lupus erythematosus, diabetes, aplastic anemia, hypertension, severe psychosis, antiviral treatment for chronic severe hepatitis, cirrhosis, hemophilia, Parkinson's disease, Parkinson's syndrome and rheumatoid arthritis. According to the income and expenditure of the local medical insurance fund and the local disease spectrum, the scope of chronic diseases and special diseases in outpatient clinics has been appropriately expanded. The proportion of urban and rural residents' medical insurance fund payment within the scope of outpatient chronic diseases and special diseases policy is not less than 50% in principle. Specific diseases and reimbursement policies shall be subject to local regulations.
be hospitalized
After deducting the hospitalization deductible line, the average reimbursement rate within the overall regional policy is about 70%, and the average annual reimbursement limit of basic medical insurance for urban and rural residents in the province is about 654.38+0.2 million yuan. The specific annual limit shall be subject to local regulations.
Critical illness insurance Welfare
Critical illness insurance is to further reimburse the insured's high medical expenses on the basis of basic medical insurance reimbursement. After the high medical expenses incurred by medical insurance hospitalization for urban and rural residents or outpatient treatment for special chronic diseases are paid by the basic medical insurance for urban and rural residents in accordance with the regulations, if the medical expenses within the scope of individual annual cumulative burden policy exceed the Qifubiaozhun for serious illness insurance, the serious illness insurance will be reimbursed in proportion. 60% of the accumulated amount is more than10.2 million yuan and less than 30,000 yuan; 65% for the part between 30,000 yuan and 654.38+10,000 yuan; 75% will be paid for the part above RMB 65,438+10,000 yuan, and the maximum annual payment limit is not less than RMB 300,000 yuan in principle.
Poor people, low-income people and people returning to poverty enjoy preferential treatment for serious illness insurance. Specifically, the deductible of serious illness insurance is 6,000 yuan, which is 6,000 yuan lower than other residents, and the reimbursement ratio is 5 percentage points higher than other residents. There is no capping line for critical illness insurance.
At the same time, in August 2022, the general office of the provincial government issued the "Implementation Opinions on Improving the Medical Insurance Assistance System for Serious and Extraordinary Diseases" to further reduce the burden of medical expenses for people in need and seriously ill patients, which will be implemented from September 1 day, 2022. In accordance with the principle of "insurance before assistance", seriously ill patients who participate in basic medical insurance and have serious difficulties in their basic family life due to high medical expenses can be reimbursed for medical assistance again according to regulations after being identified as the object of medical assistance by rural revitalization or civil affairs departments.