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The author:(作者)qqpublished in(发表于) 2013/11/27 9:14:41 Claims of serious disease of residents in Chengdu next year without Cap
Chengdu business newspaper reporter Yu Wenlong
Huimin highlights
1, serious illness insurance is a basic medical insurance system in urban and rural areas of the new item, insured persons only need to pay basic medical insurance of urban and rural residents, can enjoy as sickness insurance benefits.
2, "myasthenia gravis" into the outpatient management of specific diseases, canceled the original methods for "von Willebrand disease" students to apply child-only restrictions, broaden guarantees coverage.
Chengdu commercial reported Reporter yesterday from Chengdu city human resources and Social Security Council was informed that, next year January 1 up, Chengdu city will full implementation cover in urban and rural areas residents of big disease insurance new system, and cover all parameter insurance personnel of basic medical insurance outpatient special disease management new approach: parameter insurance personnel just paid in urban and rural areas residents basic medical premium, can by provides enjoy big disease insurance treatment, patient heavy extra disease claims not capped.
The new deal
Urban and rural residents to pay basic medical insurance
Treatment of serious illness insurance
Relevant person in charge of the Secretary for city people, severe illness insurance, basic medical insurance for urban and rural residents in the new project insured need only pay the basic medical insurance for urban and rural residents can enjoy great sickness insurance benefits according to the regulation. According to Chengdu City carried out in urban and rural areas residents big disease insurance work of implementation programme (pilot) under provides, from January 1, 2014 up, participate in Chengdu city in urban and rural areas residents basic medical insurance of parameter insurance personnel in a insurance period within occurred of hospital medical costs (containing outpatient special disease medical costs), in basic medical insurance claims Hou personal burden over last year degrees rural residents years per capita net income of meet basic medical insurance policy provides of costs, by big disease insurance by proportion claims, Overall reimbursement levels not lower than personal burdens in accordance with 50% of the basic cost of health insurance policy provides. After the merge of basic medical insurance, insurance claims, and burden of individuals in line with the basic policy provisions of the health insurance costs more than the basic medical insurance payment ceiling, its excess of basic medical insurance payment ceiling the maximum reimbursable 90%, and the total amount reimbursed does not Cap lines.
Serious illness insurance by urban and rural residents Government commissioned a commercial insurance companies bidding to host. Serious illness insurance funds from both urban and rural residents in the basic medical insurance fund on basic medical insurance for urban and rural per-capita funding allocation standard 6%, and Chengdu economic and social development level, health insurance funding capacity, higher medical costs and changes in basic medical insurance coverage and other factors carry out dynamic adjustments.
The new deal II
Outpatient coverage of specific diseases to broaden
Hospital quality improvement
City people Social Council related heads introduced, carried out party of mass line education practice activities yilai, the Council around established sound heavy extra disease guarantees mechanism, on city basic medical insurance outpatient special disease management system implementation situation for summary analysis, full sought city level related sector, and Medicare operated institutions, and Sentinel medical institutions and NPC representative, and CPPCC members, the aspects views recommends, according to national basic drug system, provides, again amendment has Chengdu city basic medical insurance outpatient special disease management approach under (following abbreviation Measures), will be implemented on January 1, 2014, is designed to further safeguard the legitimate rights and interests of insured masses, improving the quality of outpatient clinic for treatment of patients with specific diseases.
Mainly in the following five aspects of the new approach of the adjustment:
An, Chengdu will increase out-a special type of illness, "myasthenia gravis" into the outpatient management of specific diseases, canceled the original methods for "von Willebrand disease" students to apply child-only restrictions, broadens the protection cover.
Two special diseases, outpatient disease range increased from three to four, facilitate the improvements of efficiency in the use of the Fund.
Three special diseases, outpatient finds commissioned by healthcare agencies contracted medical institutions in accordance with the basic medical insurance system in Chengdu city outpatient pleading standards and issue specific implementation of specific diseases found that conclusion, insured persons access to more timely and effective treatment.
Four, the establishment of expert review system, insured on findings found that the Agency's conclusion, the objection to me insured owning health insurance agencies apply for review, by municipal health insurance expert review Panel finds that finds that conclusion.
Five, a treatment plan review system, attending doctors making preliminary treatment in medical institutions (or change) the scheme shall be made by the review experts for review, review of the adopted programme final to take effect, further protect insured persons quality of medical treatment.
(Original title: serious illness of residents in next year, reimbursement is not capped)
成都商报记者 余文龙
惠民亮点
1、城乡居民大病保险属基本医疗保险中的新增项目，参保人员只需缴纳城乡居民基本医疗保险费，即可按规定享受大病保险待遇。
2、“重症肌无力”纳入门诊特殊疾病管理，取消了原办法对“血友病”仅学生儿童可申请的限制，拓宽保障覆盖面。
成都商报记者昨日从成都市人力资源和社会保障局获悉，明年1月1日起，成都市将全面实施覆盖城乡居民的大病保险新制度、覆盖所有参保人员的基本医疗保险门诊特殊疾病管理新办法：参保人员只需缴纳城乡居民基本医疗保险费，即可按规定享受大病保险待遇，患重特大疾病报销不封顶。
新政一
缴城乡居民基本医保
可享大病保险待遇
市人社局相关负责人介绍，城乡居民大病保险属基本医疗保险中的新增项目，参保人员只需缴纳城乡居民基本医疗保险费，即可按规定享受大病保险待遇。根据《成都市开展城乡居民大病保险工作的实施方案(试行)》规定，从2014年1月1日起，参加成都市城乡居民基本医疗保险的参保人员在一个保险期内发生的住院医疗费用(含门诊特殊疾病医疗费用)，在基本医疗保险报销后个人负担超过上年度农村居民年人均纯收入的符合基本医疗保险政策规定的费用，由大病保险按比例报销，报销水平总体不低于个人负担的符合基本医疗保险政策规定费用的50%。如基本医疗保险、大病保险合并报销后，个人负担的符合基本医疗保险政策规定的费用超过了基本医疗保险最高支付限额，其超过基本医疗保险最高支付限额部分最高报销90%、且报销总额不设封顶线。
城乡居民大病保险通过政府招投标委托商业保险公司承办。大病保险资金从城乡居民基本医疗保险基金中按城乡基本居民医疗保险人均筹资标准的6%划拨，并结合成都市经济社会发展水平、医疗保险筹资能力、高额医疗费用发生情况及基本医疗保险保障水平变动等因素实行动态调整。
新政二
门诊特殊疾病覆盖面拓宽
就医质量提升
市人社局相关负责人介绍，开展党的群众路线教育实践活动以来，该局围绕建立健全重特大疾病保障机制，对全市基本医疗保险门诊特殊疾病管理制度实施情况进行总结分析，充分征求市级相关部门、医保经办机构、定点医疗机构和人大代表、政协委员等各方面意见建议，根据国家基本药物制度等规定，重新修订了《成都市基本医疗保险门诊特殊疾病管理办法》(以下简称《办法》)，将于2014年1月1日起实施，旨在进一步保障参保群众的合法权益，提升门诊特殊疾病患者的就医治疗质量。
新《办法》主要有以下五个方面的调整：
一、成都将增加门诊特殊疾病种类，将“重症肌无力”纳入门诊特殊疾病管理，取消了原办法对“血友病”仅学生儿童可申请的限制，拓宽了保障覆盖面。
二、门诊特殊疾病病种范围由三类增至四类，便于提高医保基金使用效率。
三、门诊特殊疾病认定由医保经办机构委托定点医疗机构按照《成都市基本医疗保险门诊特殊疾病认定标准》具体实施并出具认定结论，便于参保人员得到更加及时有力的治疗。
四、建立专家评审制度，如参保人员对认定机构出具的认定结论有异议，可向本人参保关系所属医保经办机构提出复查申请，由市级医疗保险专家评审小组进行复查认定并做出认定结论。
五、建立治疗方案复审制度，医疗机构主诊医生提出初步治疗(或变更)方案后，须由复审专家进行复审，复审通过的方案才能最终生效，更加保障参保人员就医治疗质量。
(原标题：明年 城乡居民重特大疾病报销不封顶)
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