Good expectations
I am Aunt Cao, the beneficiary of "Shanghai Huibao", and I am an ordinary retired worker. I had Parkinson's disease and had already made an appointment with the hospital to have surgery at the end of April this year. A few days before the operation, the family saw that the circle of friends was the news of the "Shanghai Huibao" line, and at first they did not believe it at all, saying it to the doctor, and the doctor did not believe it. Later, my lover consulted with all parties, consulted with the doctor, and with the mentality of trying it out, postponed the operation to July. After I was successfully discharged from the hospital, I quickly let my daughter apply for a specific hospital self-pay medical insurance premium on the application app, and the money arrived in less than three days, and the compensation was nearly 140,000 yuan, which was incredibly fast.
To be able to save such a large amount of money, our whole family is really grateful to the "Shanghai Huibao", 115 yuan a year is very affordable, the operation is also convenient, the mobile phone point does not have to go out, bringing us real benefits, reducing our burden a lot.
I hope that in the future, more people can know about the "Shanghai Huibao", if you buy, even if you do not enjoy the benefits of the "Shanghai Huibao", it is indirectly helping others and doing good deeds.
Ask the people of Shanghai this year
What is your favorite influencer product?
"Shanghai Huibao" must be counted as one
As the first inclusive urban customized commercial medical insurance product officially released in Shanghai on April 27 this year, the number of insured people in the first year reached 7.39 million, and in Shanghai, where the number of basic medical insurance participants is about 19 million, less than 1 in 3 people have applied for "Shanghai Huibao". As of November 30, Shanghai Huibao has accepted a total of 66,600 claims and received 64,100 claims, with a compensation amount of 299 million yuan, adding another protection for insured persons when they are seriously ill.
As of November 30, "Shanghai Huibao" has accepted a total of 66,600 claim applications, received 64,100 claims, and paid 299 million yuan
High medical expenses are added to the protection
Ms. Li, 68 years old who has been insured by "Shanghai Huibao", was hospitalized in a top-three hospital in Shanghai due to arterial embolism and thrombosis from July 29 to August 5, underwent surgical treatment and placed in a brain pacemaker, with a self-payment of 222,500 yuan within the scope of the claim. On August 12, Ms. Li's daughter submitted a claim application on the "Sui Bidding" app and authorized the use of medical insurance electronic diagnosis and treatment data. After deducting the deductible, 141,800 yuan was paid according to 70% of the non-pre-existent disease, and the compensation arrived on August 17. Ms. Li and her family praised the "Shanghai Huibao" for the convenience and timeliness of the settlement of claims, which is really doing good things for the masses.
According to the Shanghai Medical Insurance Bureau, the self-paid medical expenses outside the scope of medical insurance are easy to become the risk points that induce large medical expenses of families in the city, while traditional commercial insurance products often have the problem of "the elderly cannot afford to buy, patients cannot buy", therefore, "Shanghai Huibao" will focus on the protection responsibility on self-paid medical expenses, including specific hospitalization self-pay medical costs, specific high drug costs and proton, heavy ion medical costs, and further improve the multi-level security system, fully reflecting the local medical advantages.
Shanghai's first inclusive urban customized commercial medical insurance product, with 7.39 million insured people in the first year
"People looking for policies" to "policies to find people"
Poverty caused by illness and returning to poverty due to illness
It is a stumbling block on the road to common prosperity
In real life
How to make the "root of the disease" no longer become the "root of poverty"?
In June this year, Pudong, Jing'an, Yangpu, Minhang, Jiading and Chongming took the lead in the establishment of an early warning mechanism for poverty caused by illness in the city, through dynamic and normalized monitoring and early warning, early identification and discovery of poverty due to illness and return to poverty risk groups, timely docking rescue and support and other policy measures, from "people looking for policies" to "policies to find people", committed to reducing the medical burden of sick and difficult groups, preventing and resolving the risk of returning to poverty due to illness, so that the people in difficulty can afford to see the disease and cure the disease well.
In the early warning list of Minhang District in August 2021, Ms. Cao, a 57-year-old villager in Qunyi Village, Pujiang Town, had a total medical expense of 82,777 yuan from January to August this year, and her own expenses reached 53,800 yuan, and the Pujiang Town Community Affairs Acceptance Service Center quickly sent community rescue consultants to understand the situation.
A few years ago, Ms. Cao unfortunately found uremia, in order to treat the disease not only spent all the family's savings, but also owed foreign debt, husband Mr. Shen retired salary of more than 4,000 yuan. After understanding the situation clearly, Pujiang Town quickly launched the working mechanism of poverty caused by illness, benchmarked the existing policies, fully mobilized the participation of social assistance forces, and formulated a "one household, one plan" professional assistance plan for it.
"Shanghai Insurance" focuses the protection responsibility on out-of-pocket medical expenses, further improves the multi-level security system, and fully reflects the advantages of local medical care
In September 2021, the Qunyi Village rescue consultant helped her collect low-income family verification materials in the fastest time, after passing the information check, in line with the identification standards of low-income families, immediately carried out medical assistance for its annual invoice, the actual amount of assistance was 39320 yuan, and at the same time connected to the town rescue department, taking it as a key object to actively track attention, and carry out systematic and long-term help, do a good job in the filing of New Year's Day Spring Festival assistance, charitable foundations and citizen help, so as to regularly visit the condolences, Implement caring for pairing, and give her life care, psychological counseling and other aspects of help, is committed to reducing the medical burden of the sick and difficult groups, preventing and resolving the risk of poverty caused by the disease, and realizing the multi-level comprehensive protection of the difficult groups.
Escort the disabled elderly
Uncle Zhu, an 80-year-old man who lives in Baoshan District, was admitted to the hospital for craniotomy due to acute cerebral hemorrhage, resulting in hemiplegia lying in bed, completely unable to move his body, and unable to communicate and take care of himself. Because his children were not around, he only relied on his 70-year-old wife to take care of his daily life, and he was miserable, and even his wife was exhausted and admitted to the hospital several times. After applying for long-term care insurance home care, the nursing staff according to the actual situation of the elderly, home to customize a special nursing plan, to help the elderly to do bathing, life self-care ability training and other projects, after daily careful care, the elderly from lack of sanity, unable to communicate to be able to communicate with the caregiver with simple limbs, eyes. A few days ago, the elderly have gone from being completely bedridden, to being able to sit up simply, and then to being able to walk slowly under the bed. In terms of speech, although I still can't pronounce words, I can express my preferences and wishes with my eyes and movements. In this regard, the family members have greatly recognized the long-term care insurance policy and expressed their gratitude many times.
It is understood that the Shanghai Medical Insurance Bureau has incorporated the management of long-term care insurance disabled elderly contract services into the performance appraisal of family doctors' contracted services in the city, and on this basis, promote conditional nursing service institutions to further understand and record the disease status of the elderly, explore linkage with community family doctors and health files, and improve service quality.
In order to solve the problem of the city's disabled elderly settling long-term care insurance in the Yangtze River Delta off-site pension institutions, Shanghai launched the pilot project of extended settlement of long-term care insurance costs for the elderly in the Yangtze River Delta region in January this year. Through the mayor's nursing insurance designated brand pension institutions as the main body, relying on the pension chain institutions it opened in the Yangtze River Delta, the extension of the city's disability elderly long-term care insurance treatment in the Yangtze River Delta in the Yangtze River Delta has been realized. At present, there are 15 chain pension institutions that meet the relevant conditions, and they have been included in the list of pilot pension institutions for the extended settlement of long-term care insurance in the mayor's triangle region.
Numbers speak
In the cases of "Shanghai Huibao" receiving compensation, women accounted for 49% and men accounted for 51%; from the perspective of age structure, 18 to 65 years old accounted for 54%, of which 26 to 50 years old accounted for 20% of the total number of compensation cases; 65 years old and over accounted for 44%, and 18 years old accounted for 2%. Among the insured who receive the benefits, the youngest is only 1 year old, the oldest is 100 years old, and the maximum amount of a single payment is 300,000 yuan.
Up to now, the mayor's nursing insurance pilot has served a total of 393,000 disabled elderly people, including 326,000 community home care and 67,000 elderly care institutions. The average age of disabled elderly people who enjoy long-term care insurance home care and institutional care in the city is 80.1 years old and 85 years old, respectively.
There are 36 fixed-point assessment institutions for long-term care insurance in the city, with 10,000 assessors. At present, there are 68,000 people in the city who are included in the registration of long-term care insurance. There are 1,228 designated nursing service institutions for long-term care insurance.
In June this year, the Shanghai Municipal Medical Insurance Center issued the first batch of 8,071 early warning lists to six pilot areas. After investigation, a total of 6979 people have been identified as medical aid targets and helped complete the reimbursement of rescue expenses, accounting for 86.5% of the early warning list, and the total amount of assistance is 113 million yuan.
Gold Coast Studio
Author | Tu Yu
Photography | Liu Xin
Edited | Beam group