On the afternoon of June 5438+03, Ministry of Human Resources and Social Security held a press conference that China won the "Outstanding Achievement Award in Social Security" awarded by the International Social Security Association. In view of the progress of the direct settlement of hospitalization expenses for medical treatment in different places, Huang Zai, deputy director of the Social Insurance Management Center, said on 13 that the Ministry of Finance and the Ministry of Finance had jointly issued a document a few days ago, and the target task was to basically realize the nationwide networking by the end of 20 16 and start the direct settlement of hospitalization expenses for retirees seeking medical treatment in different places; 20 17 gradually solve the direct settlement of hospitalization expenses for retirees resettled in different places across provinces, and expand it to the direct settlement of hospitalization expenses for those who meet the referral conditions at the end of the year.
20 17 new medical insurance policy ii: there are two major breakthroughs in medical treatment in different places.
In response to a reporter's question, the relevant person in charge said that in order to do a good job in direct settlement of hospitalization expenses in different places, Ministry of Human Resources and Social Security set up a special working group, formulated a work plan, defined the tasks, reversed the time and concentrated on tackling key problems. At present, some major breakthroughs have been made, mainly in two aspects:
On February 9, 65438, Ministry of Human Resources and Social Security and the Ministry of Finance jointly issued the Notice on Doing a Good Job in Direct Settlement of Hospitalization Expenses for Basic Medical Treatment in Different Provinces. This is the number 20 16 120 issued by Ministry of Human Resources and Social Security. The document defines the objectives and tasks, basic principles, main policies, settlement methods, handling procedures, responsibilities of provincial platforms, and information system construction.
Last week, the national settlement system for medical treatment in different places passed the preliminary acceptance. This marks the official shift of this work from policy decision-making and system construction to policy implementation and trial operation of inter-departmental and inter-provincial system docking. At the same time, strengthen the dispatch of Beijing-Tianjin-Hebei, Shanghai, Guangdong and other places, and urge all localities to achieve cross-provincial medical insurance settlement this year, and make preparations for docking with ministerial-level systems.
20 17 new medical insurance policy 3:20 17 realize the direct settlement of medical expenses of compliance personnel in different places at the end of the year.
When can the direct settlement of medical expenses in different places be realized, Ministry of Human Resources and Social Security also gave the answer:
20 16 basically realizes national networking, which is a key word.
Initiate direct settlement of hospitalization medical expenses for retirees resettled in different places across provinces. One of the key words is "start". In addition, there are retirees who are resettled across provinces and different places, not all retirees.
On 20 17, the direct settlement of medical expenses for retirees in different places across provinces began, not by the end of 20 16, but by the end of 20 17.
20 17 new medical insurance policy 4: 20 17 residents' medical insurance payment policy
First, appropriately adjust the individual payment standard. With the improvement of medical consumption level, the state's financial subsidy for residents' medical insurance has increased year by year, and the individual payment standard of 20 17 will also be appropriately raised. The payment standards are 100 yuan for students and children 60 yuan, elderly residents over 60 years old and other unemployed urban residents 300 yuan, which are increased by 10 yuan, 30 yuan and 100 yuan respectively. The subsistence allowances, the disabled and the "three noes" individuals still don't have to pay.
The second is the "retrospective" reimbursement of medical expenses for newborns. According to the new policy, newborns pay residents' medical insurance within 90 days (including 90 days) from the date of birth, and the medical expenses for hospitalization due to illness from the date of birth can be paid by the medical insurance fund according to regulations.
Third, we can't "bind" the outpatient appointment institution without authorization. From 20 17 65438+ 10/0/day, insured residents can enjoy outpatient co-ordination treatment according to regulations when they come to the selected outpatient appointment institution for the first time with the medical certificate. There is no need to make an appointment in advance, and the outpatient appointment institution shall not "bind without authorization" against the wishes of the insured residents.
20 17 new medical insurance policy 5: 20 17 medical insurance reimbursement
I. 20 17 reimbursement scope of medical insurance for serious illness
1. Malignant tumor treatment: including chemotherapy (including endocrine-specific anti-tumor therapy), radiotherapy, isotope anti-tumor therapy, interventional anti-tumor therapy and traditional Chinese medicine anti-tumor therapy.
2. Outpatient hemodialysis and peritoneal dialysis for severe uremia.
3. Anti-rejection therapy after renal transplantation.
4. Treatment of severe mental illness: schizophrenia, depression (moderate or severe), mania, obsessive-compulsive disorder, mental retardation with mental disorder, epilepsy with mental disorder, paranoid psychosis.
It should be noted that the following situations are not within the scope of reimbursement of serious illness medical insurance:
1. See a doctor in a non-designated hospital without approval (except for emergency rescue);
2. Suffering from occupational diseases, work-related injuries or recurrence of old injuries; Injuries caused by traffic accidents;
3. Injury caused by my illegal behavior;
4. Food poisoning caused by accidents;
5. Being treated for suicide (except psychotic episode);
6. Injuries caused by medical accidents;
7. According to the regulations of the state and this Municipality, medical expenses should be taken care of.
Second, the proportion of serious illness medical insurance is 20 17
1. Deductible: 20,000 yuan. More than 20 thousand can be reimbursed through serious illness medical insurance.
2, serious illness medical insurance deductible above the reimbursement ratio is:
1) 20,000-50,000 yuan: 50% reimbursement for critical illness medical insurance;
2) 50,000 yuan-65,438+10,000 yuan: the medical insurance for serious illness is reimbursed by 60%;
3) More than RMB 65,438+10,000: 70% of the medical insurance for critical illness will be reimbursed.
3. Upper limit of annual reimbursement: 300,000.
Iii. Reimbursement Process of Serious Illness Medical Insurance 20 17
1. Materials required for reimbursement of serious illness medical insurance
1) ID card of the insured;
2) medical insurance or medical insurance card of the insured;
3) Original and photocopy of medical expense settlement list.
2. Serious illness medical insurance reimbursement process
1) The insured shall bring the above materials to the medical insurance department of the local designated hospital to fill in the relevant forms for preliminary examination; 2) Designated hospitals will report the information of insured residents who have passed the preliminary examination to the urban medical insurance agency for review;
3) The insured residents who pass the final examination shall be reimbursed by the urban medical insurance agency for serious illness medical insurance.
Four, 20 17 years of serious illness medical insurance reimbursement
It has been two years since the first diagnosis or recurrence of malignant tumor, of which Chinese medicine treatment for malignant tumor can be enjoyed for five years.
20 17 what changes have been made in the new medical insurance policy for serious illness compared with previous years? Its changes are mainly reflected in the following aspects: 1. Reduce the minimum payment standard: the minimum payment standard is reduced from 20,000 yuan to 1.8 million yuan.
2. Increase the proportion of reimbursement: among them, the proportion of adult residents, children and college students who participate in Class I payment will be increased from 60% to 65%; The proportion of adult residents participating in the second payment has increased from 50% to 55%.
3. Increase in the over-limit subsidy: 90% of the employees' medical insurance participants will be reimbursed; Residents' medical insurance participants, adult residents, children and college students will be reimbursed 80% in the first file and 70% in the second file.
4. Increase in large subsidies: 75% of employees' medical insurance participants will be reimbursed; 60% reimbursement for adult residents, children and college students who pay the first grade; Adult residents who pay the second grade will be reimbursed 50%.
5. Free vaccination for children: Children over 4 years old receive the second dose of varicella vaccine free of charge.
20 17 questions and answers on the new medical insurance policy
First, how to use the money in the medical insurance card account
As we all know, employee medical insurance is generally divided into personal accounts and overall accounts. How to use these two accounts respectively?
Personal accounts can pay the following fees:
1. Drug purchase expenses of designated retail pharmacies, outpatient and emergency medical expenses;
2. Used to purchase commercial insurance and accident insurance;
3 basic medical insurance fund Qifubiaozhun below the medical expenses;
4 more than the basic medical insurance fund Qifubiaozhun, the expenses borne by individuals in proportion;
5. I'll pay for the part of my personal account that is insufficient to pay.
The overall fund mainly pays the following fees:
1, hospitalization expenses;
2, malignant tumor radiotherapy, renal dialysis, kidney transplantation after taking anti-rejection drugs outpatient medical expenses;
3, emergency rescue income hospitalized patients, the medical expenses within seven days before hospitalization.
Second, the scope of medical insurance reimbursement
1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents.
The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%.
Self-funded drugs are not reimbursed, and 80% of Class B drugs are reimbursed. The bed fee is limited, and some inspection fees and medical treatment fees cannot be reimbursed according to regulations.
2. The reimbursement amount of the medical insurance card is 4 times of the local social wage (1 year accumulated value).
3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.
4. Reimbursement of serious illness insurance
After the insured suffers from a serious illness, the personal conceit part that meets the requirements of the municipal medical insurance in the designated medical institutions of the municipal medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% shall be reimbursed by the serious illness insurance fund.
That is, reimbursement amount = self-funded part ×50%
Third, the proportion of medical insurance card reimbursement
In July this year, Ministry of Human Resources and Social Security announced the outline of the 13th Five-Year Plan for the development of human resources and social security. China should stabilize the proportion of hospitalization expenses in the basic medical insurance policy for employees and urban and rural residents at around 75%.
Fourth, the new use of medical insurance card
1 can be used as an ID card.
20 15 10 1, the criminal law amendment (IX) included the social security card in the scope of documents that can be used to prove identity according to law. Whoever forges, alters or buys or sells social security cards shall be investigated for criminal responsibility according to law; Anyone who uses a forged, altered or embezzled social security card of others shall be investigated for criminal responsibility according to law.
2. Some provinces and cities can keep fit.
In the second half of this year, in some provinces and cities in Shandong, Chongqing and Jiangsu, employees themselves can use their personal account balance to carry out fitness activities in fitness venues. But it shall not be used to buy food, clothing, fitness equipment or cash.
Five, the use of medical insurance card should pay attention to matters.
1. Cash withdrawal is prohibited.
No unit or individual may violate the scope and requirements of the medical insurance card, and it is strictly forbidden to take cash.
2. Some provincial and municipal medical insurance cards can be used by the whole family.
Starting from the second half of this year, in some provinces and cities such as Zhejiang Province and Guangzhou City, the surplus funds of individual medical insurance accounts over the years can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, so as to realize mutual assistance among family members.
3. The following medical insurance will not be paid.
See a doctor in a non-designated medical institution or buy medicine in a non-designated retail pharmacy (except for emergency);
Self-injury caused by fighting, drug abuse or other illegal acts;
Treatment for alcoholism, suicide, self-mutilation, etc.;
Injuries caused by traffic accidents, medical accidents or other accidents;
And the situation that should be paid by individuals according to national or local regulations.
6. How to check the balance of the medical insurance card?
Insured persons can call 12333 for social security consultation or check the balance of medical insurance personal account through BOC savings office, designated hospitals in urban areas and pharmacies.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.