Guangdong plans to adjust the three major changes of serious illness insurance

Source: medical geography 2016-06-06 according to the opinions on the implementation of improving serious illness insurance in urban and rural areas in Guangdong Province (Draft for comments) (hereinafter referred to as draft for comments) posted on the official website of the Department of human resources and social security of Guangdong Province, Guangdong plans to integrate the serious illness insurance policies of employees and urban and rural residents in the next year, unify the financing standards, treatment levels, etc At the same time, the insurance limit of serious illness medical insurance has also been greatly increased In principle, it is required to be no less than four times of the average annual wage of the on-the-job employees in each overall planning area in the previous year, especially for the poor groups such as the low-level insured The policy is to come into effect on July 1 this year Guangdong plans to integrate the serious illness policy of employees and residents Relevant documents are seeking public opinions 1 The serious illness insurance will be integrated compared with the current serious illness insurance policy The most significant change in the draft is to propose to "integrate the serious illness insurance policy of employees and urban and rural residents" The relevant statements in the draft are as follows: in combination with the promotion of the urban-rural integration reform of basic medical insurance, explore mechanism innovation, integrate the policy of serious illness insurance for employees and urban and rural residents, unify the financing standards, treatment level, bidding, service management and information system The schedule is given in the consultation - by the end of 2016, all regions will further adjust and improve the serious illness insurance system By 2017, we will establish and improve the serious illness insurance system covering all employees and urban and rural residents "This is really a big change," said the person in charge of Guangzhou Medical Insurance Department Taking Guangzhou as an example, there are two categories of the current serious illness medical insurance system: one is "medical subsidy for major illness of employees" and the other is "medical insurance for major illness of urban and rural residents" The original idea of system design is to extend it on the basis of employee medical insurance and urban and rural residents, which are totally two different systems For the insured of medical insurance in Guangzhou, whether they are employees or urban and rural residents, they do not need to pay for medical insurance for serious illness, and the reimbursement limit is totally different It is understood that the annual reimbursement limit of serious illness insurance for Guangzhou employees is "three times of the average annual wage of the employees in the city in the previous year"; while the maximum amount of serious illness insurance for urban and rural residents in Guangzhou is a fixed number, with the maximum amount of 120000 yuan The maximum amount of continuous insurance (calculated from 2015) for two years can be raised to 150000 yuan, and the maximum amount of continuous insurance (calculated from 2015) for five years can be raised to 180000 yuan Change 2: the upper limit of reimbursement will be greatly increased According to the draft, each overall planning area should take into account the local economic and social development level, the financing capacity of basic medical insurance, the high medical expenses of insured personnel suffering from serious illness, the level of insurance coverage for serious illness and other factors, make a scientific and detailed fund calculation, and reasonably determine the financing standard of serious illness insurance In principle, it is about 5% of the basic medical insurance fund income, and it should be adjusted reasonably according to the fund income and the change of medical expenses In terms of treatment, the draft has brought many benefits to the people The draft requires all localities to set reasonable starting standards and annual maximum payment limits Specifically, the starting standard of the serious illness insurance shall be reasonably determined according to the compliance medical expenses that the individual bears accumulatively in each year exceeding the per capita disposable income of urban and rural residents in each overall planning area in the previous year, and shall not be higher than the per capita disposable income of urban residents in the previous year In principle, the annual maximum payment limit of serious illness insurance shall not be less than 4 times of the annual average wage of the on-the-job employees in each overall planning area in the previous year Change 3: the draft for consultation on no upper limit of reimbursement for difficult groups also requires reasonable determination of payment proportion All localities should establish and improve the payment mechanism by sections, and set up the payment proportion of serious illness insurance by sections according to the level of medical expenses The higher the medical expenses are, the higher the payment proportion is, and the payment proportion is not less than 50% With the continuous improvement of financing, management and security level, the proportion of payment for serious illness will be gradually increased to minimize the medical expenses of the insured Another new formulation of the draft is to "incline to the disadvantaged groups appropriately" According to the draft for comments, the preferential payment policy is implemented for the urban and rural poor population, including the poverty population with filing cards, the people who are supported by the five guarantees and the people who are covered by the minimum insurance The starting payment standard for serious illness insurance is reduced by 50%, the payment proportion is increased appropriately, and the annual maximum payment limit is not set In addition, the draft also proposed to promote the "one-stop" settlement of medical expenses Promote the connection of basic medical insurance, serious illness insurance and urban-rural medical assistance information system, realize the sharing of personnel information, medical information and medical expense information, implement the "one-stop" direct settlement of basic medical insurance, serious illness insurance and urban-rural medical assistance, ensure the convenience of the masses, timely enjoy various medical insurance benefits, and reduce the pressure of advance payment According to the system design idea of the draft, the improvement of this urban and rural serious illness insurance aims to form a multi-level medical insurance system with basic medical insurance (usually called medical insurance), serious illness insurance and supplementary medical insurance as the supplement, urban and rural medical assistance and disease emergency rescue as the minimum, forming a joint force of security, We will work together to play a supporting role After the reimbursement of serious illness medical insurance, what should we do if the money is not enough? According to the draft, the civil affairs department and other departments should timely implement the relevant rescue policies for the insured who still have difficulties in self financing after the payment of serious illness insurance We will encourage the Red Cross Society, the Charity Federation and other public welfare organizations and social capital to develop charity relief undertakings Encourage commercial insurance institutions to develop health insurance products that meet different needs and meet the diverse health needs of the masses 2 The insurance company participated in the draft for Soliciting Opinions on tax reduction and exemption, supporting commercial insurance institutions to undertake serious illness insurance In principle, all localities shall select qualified commercial insurance institutions to undertake serious illness insurance business through public bidding by the government In the case that the undertaker can not be determined by the normal bidding and investment, the local government shall make clear the method for the formation of undertaker For the premium income of commercial insurance institutions undertaking serious illness insurance, business tax and insurance business supervision fee shall be exempted in accordance with the current provisions; and insurance guarantee fund shall be exempted in accordance with the state provisions According to the draft for comment on "blacklist" of insurance companies' fraudulent insurance, the social insurance agency shall terminate the contract for commercial insurance institutions to compete maliciously in the bidding process of serious illness insurance, to defraud the basic medical insurance fund expenditure by fraud, forgery of certification materials or other means, and to be severely punished in violation of the regulations of the regulatory authorities, It is not allowed to undertake the social insurance business in this overall planning area within three years For the commercial insurance institutions that can strictly perform the serious illness insurance contract and effectively improve the handling service level, the next round of serious illness insurance bidding can be undertaken preferentially under the same conditions Feedback network: before June 18, 2016, citizens, legal persons and other organizations can log on the website of Guangdong Provincial Department of human resources and social security (http://www.gdhrss.gov.cn/, The column of "asking for opinions on the Internet" on the left side of the bottom of the website) letter: written opinion letter mailed (please indicate "asking for opinions" outside the letter) address: medical insurance office, Department of human resources and social security, Guangdong Province, No 88, Jiaoyu Road, Guangzhou 510030 Tel: (020) 83194109