Medical network - on March 7, recently, the guangxi people club hall issued "interim measures for guangxi urban and rural residents basic medical insurance" (hereinafter referred to as the "method"), after the integration of urban and rural residents basic medical insurance scope of ginseng, ginseng protect registration, payment method, medical treatment, cost, the method of payment and other relevant policies to clear.
Window one: ginseng range covers more people
After the integration of urban and rural residents basic medical insurance system, the original employee basic medical insurance system, basic medical insurance system for urban residents from the three medical security, the new rural cooperative medical system into two system, therefore, "method" regulation of urban and rural residents basic medical insurance ginseng protect range, except the worker is basic medical treatment insurance coverage to all urban and rural residents, including college students. Ginseng protect all covered all populations in guangxi, the basic implementation for all target of insurance of primary medical treatment.
Highlight 2: protect capture the government subsidies
Urban and rural residents per person per year as stipulated in the state and the autonomous region is the pay cost standard of pay is basic medical treatment insurance premium, at the same time, governments at all levels to participate in urban and rural residents basic medical insurance personal universality subsidy policies. 2016 urban residents in guangxi to attend insurance of primary medical treatment to expend 540 yuan per capita, in which individual capture to expend 120 yuan, all levels of government subsidies of 420 yuan. Attend insurance of primary medical treatment of urban and rural residents in guangxi in 2017 individual pay cost 150 yuan.
"Method" article 12 in the fourth paragraph, the difficulties of the urban and rural residents, the special groups (including low object, severely disabled, low-income families and minors, of all people over 60 years old and infirm, inputting the tent card, rural poverty population to carry out the family planning policy to one-child families and double female JieZaHu parents and their children, border 0-20 km of urban and rural residents, etc.) join the part of individual pay cost required, subsidies granted by governments at all levels according to stipulations.
Point three: capture expends time to two or morethings migrant groups
Article 17 of the "method" clear "urban and rural residents shall, in each year on September 1 solstice December 31, pay New Year insurance premium of primary medical treatment". For many migrant farmers group in the special case of concentrated home before the Spring Festival, "method" regulation "part of the urban and rural residents have difficulty in payment on time, can delay to the New Year at the end of February, after full specified amount payment enjoy treatment of insurance of primary medical treatment of New Year." Convenient to protect capture such groups.
To prevent speculative ginseng and ginseng to keep happening only sick, "method" in paragraph 3 of article 17 of the ginseng of interrupt capture to expend. Interrupt capture to expend more than 1 year renewal of the staff, since the insurance premium of primary medical treatment of pay of full specified amount, from 3 months to 1 day begin to enjoy the new treatment of insurance of primary medical treatment." The fourth paragraph of "urban and rural residents of overdue payment, the insurance premium of primary medical treatment of pay of full specified amount, from the following month 1 begin to enjoy the new treatment of insurance of primary medical treatment."
Point four: fund to pay limits have expanded
According to the types of "basic is complete, the overall structure is reasonable" requirements, through the integration of the guangxi zhuang autonomous region, the basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue and the new type of rural cooperative medical care in guangxi medicine directory, supplemented by drug directory. The original urban residents health care medical services than new farming and more wide, according to the principle of "directory is not narrow wide", "method" provided for in article 22 of the urban and rural residents basic medical treatment insurance to pay limits, in accordance with the "the guangxi zhuang autonomous region, the basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue, the guangxi zhuang autonomous region, the basic medical insurance and medical service items of inductrial injury insurance" unity, is beyond the scope directory will not be paid. Integrated outpatient special types of chronic disease and two systems has increased than ever before.
Point 5: establishing outpatient service medical treatment as a whole is not a family account or personal account
Chapter 8 of the measures for the specific provisions for establishing outpatient service medical treatment as a whole, ginseng protect personnel as a fixed-point medical institutions should choose a level and below outpatient medical service institutions, ginseng protect personnel in himself not selected outpatient fixed-point medical institutions for medical treatment of pay medical treatment fee will not be as a whole. Clear "outpatient service medical treatment as a whole is not a family account or personal account". Original new farming and ginseng protect personnel to family account has a balance, can continue to use, can be used to pay in accordance with the basic medical insurance to pay limits of outpatient service medical treatment as a whole, outpatient service special chronic diseases, hospitalization should oneself by the individual to pay medical treatment, family account funds run out.
Point 6: medical expenses reimbursement ratio differences reflect the classification system
In addition to the medical system, to guide the ginseng protect personnel to the grassroots medical institutions in hospital, reduce the medical cost, differentiated in the proportion of different grade medical establishment that decide a dot to submit an expense account. In the primary medical expenses of outpatient service special insurance of primary medical treatment chronic diseases and the ranks of the medical establishment that decide a dot below reimbursement, fund pays 85%, the personal burden of 15%, in the secondary, city level 3 and municipality level medical establishment that decide a dot medical reimbursement ratio of 70%, 55% and 50% respectively. Hospitalization medical treatment of insurance of primary medical treatment in the primary and the ranks of the medical establishment that decide a dot below reimbursement, fund pays 90%, the personal burden of 10%, in the secondary, city level 3 and municipality level medical establishment that decide a dot medical reimbursement ratio of 75%, 60% and 55% respectively.
Point 7: domestic sickbed further standardize management
In view of the present building across family sickbed policy not unified, the integration of urban and rural medical insurance system, unified the domestic sickbed management system, provide the basis for local, to facilitate handling operation; Means all urban and rural residents, in line with the conditions in accordance with the provisions, establish a domestic sickbed ginseng protect personnel to treat in the home also can enjoy the benefits of health care. The provisions of article 27 of the "method", "building bed cycle is not more than 90 days at a time, a ginseng protects, within the year, in principle, most building bed 3 times, every settlement annual accumulative total does not exceed 180 days".
Window eight: birth medical treatment will be greatly improved than before
"Method" article 29 of the clear "protect people conform to the state, autonomous regions the family planning policy, related birth happens in outpatient service medical treatment of pay according to provisions of outpatient service medical treatment as a whole, fertility, obstetric complications, such as medical treatment in hospital reimbursement the proportion stipulated by the hospital", compared with the previous birth medical treatment executes fixed reimbursement will be greatly increased.
Window nine: accidental injury medical treatment cost can be paid by the fund of insurance of primary medical treatment first
For accidental injury medical treatment, "method" article 30 clear "students on campus or in the school activities organized by the school, as well as the accident harm accident on his way to and from school in the year of outpatient medical treatment cost 5000 yuan (contain 5000 yuan), paid by the fund 80%, be treated as outpatients, to pay the proportion stipulated by the hospital". "Ginseng protect personnel accident harm, of medical expenses shall be borne by the third person in accordance with the law, the third person does not pay or not sure of the third person, pay by fund of insurance of primary medical treatment first."
Window ten: emergency reimbursement ratio under observation in hospital regulations
In order to solve some ginseng protect personnel due to illness in increasing medical expenses of outpatient service rescue produce high personal burden, in article 26 of the methods defined "ginseng protect personnel due to illness in three, two, level 1 emergency under observation in the medical establishment that decide a dot, do not turn to hospital treatment conforms to the basic medical insurance to pay limits of medical expenses, the fu biao since each fund 300 yuan respectively, 200 yuan, 100 yuan, deducted from conforms to the total amount of funds to pay; the rest of the medical expenses, as stipulated in the hospital reimbursement ratio execution."
Point 11: as a whole fund is top pay limitation to be six times that of the urban residents per capita income
In accordance with the "treatment by high not low" principle, "method" in paragraph 6 of article 27 "ginseng protect personnel in ginseng year, fund is top pay limitation for each year on January 1st the latest statistics department 6 times of the year in guangxi urban per capita disposable income". In 2015 in guangxi urban per capita disposable income of 26416 yuan, per capita net income of farmers 9467 yuan, urban and rural medical insurance plan as a whole fund is top pay limitation, than the original new farming and highest pay limitation to be 6 times per capita net income of farmers.
Window 12: the establishment of a multi-level medical security system
In order to make health care coverage to more groups, especially the phenomenon to gradually eliminate poverty due to illness, the methods of continue to implement the special policy of the new farmers, such as the document of the tent card ginseng protect personnel to poor treatment of special outpatient service medical treatment of chronic diseases, hospitalization in the fund on the basis of reimbursement ratio increased by 5%. Also after expenses of insurance of primary medical treatment, still difficult to solve the high medical costs difficult ginseng protect people to provide more security channel between urban and rural areas, "method" article 31 has been clear about the basic medical insurance and medical insurance, medical treatment of a serious illness and poverty alleviation policy of corresponding regulations, establish a multi-level medical security system.
"Interim measures for guangxi urban and rural residents basic medical insurance" will be in July 1, 2017 formally implemented, the basic medical insurance for urban residents and the new rural cooperative medical documents shall be repealed simultaneously. Before the formal implementation, and social security departments at all levels and medical institutions will be according to the interim measures for the preparatory work. |
