The implementation plan of pilot work of serious illness insurance for urban and rural residents in Urumqi (for Trial Implementation) (hereinafter referred to as the implementation plan) was promulgated. From 20 15 1 month 1 day, Urumqi will establish a serious illness insurance system for urban residents. In order to ensure the implementation of the pilot project of serious illness insurance for urban residents, Urumqi has increased the payment limit of basic medical insurance for urban residents, from the current 30,000 yuan to 90,000 yuan. After adjusting the basic medical insurance benefits for urban residents, the insured will no longer pay the large Medicaid insurance premium for urban residents originally entrusted by commercial insurance companies.
Urban and rural residents' serious illness insurance is a system that, on the basis of the basic medical insurance for urban residents and the basic guarantee of the new cooperative medical system in agricultural and pastoral areas, the insured (co-insured) suffers from high medical expenses, and the eligible medical expenses that need to be borne by the urban residents after the medical insurance and the new rural cooperative medical system are compensated again, and the compensation again is not less than 50% of the actual expenses.
Tang Hengyi, director of the Medical Insurance Department of Urumqi Municipal People's Social Security Bureau, said that at present, the reimbursement level of basic medical insurance for urban residents in Urumqi has reached 70%, but the reimbursement limit is currently divided into two levels, namely, basic medical insurance for residents' medical insurance and large medical assistance insurance for residents' medical insurance. Among them, the overall basic medical insurance is 30,000 yuan, and the large medical assistance is 60,000 yuan, * * 90,000 yuan. At present, there are 585,700 urban residents in Urumqi who have participated in the basic medical insurance, but the large amount of medical assistance is voluntary, with only 300,000 people participating in the insurance. Many people only enjoy the basic medical insurance, but they do not enjoy the large amount of medical assistance. One of the main reasons is that the large amount of medical assistance insurance is borne by commercial insurance companies, and individuals need to pay, and adults have to pay 80 yuan and minors have to pay 20 yuan.
Those who participate in the basic insurance for urban residents are naturally eligible for serious illness medical insurance, and no individual needs to pay again; According to the different medical expenses paid by individuals, there are four grades, of which the lowest design is 50% and the file design is 65%; The reimbursement limit of the established serious illness system for urban residents is not capped, which means that the compliance medical expenses paid by individuals, no matter how much you spend, can enter the scope of serious illness reimbursement; Serious illness insurance mainly guarantees the compliance medical expenses paid by individuals after the insured residents get sick and are reimbursed according to the basic medical insurance.
Tang Hengyi gave an example: if a resident spends 50,000 yuan on hospitalization, 20,000 yuan is reimbursed for basic medical insurance, and the remaining 30,000 yuan is paid out of pocket, because it exceeds 1.5 million yuan, it can be reimbursed for serious illness; If there is no out-of-pocket medicine for 30,000 yuan, subtract 1.5 million yuan from the deductible line, and according to the regulation that 50% of the self-paid compliant medical expenses are subsidized, the serious illness insurance can reimburse 7,500 yuan.