After the daily hospitalization cost of 300,000 yuan for a patient, after the medical insurance pooling fund, major illness insurance and special outpatient (outpatient major illness) reimbursement, is there any other channel to report?
In addition to the commercial insurance purchased by individuals, the government also has a policy bottom for special personnel, that is, medical assistance for serious illnesses, reasonable expenses that are not reported by social security, and the government will also report a part, medical assistance is not insurance, and the government pays for it.
The topic of this issue will talk about the difference between medical assistance for major illnesses and medical insurance for major illnesses, and give examples of some urban medical assistance policies.
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Take the inpatient treatment of residents in a city as an example:
Suppose that Mr. Liu is in the provincial third-class hospital, because of liver cancer, the cost of hospitalization is 140,000, self-funded medicine is 30,000, and the hospitalization period:
Step 1:
Medical insurance pooled account reimbursement: (140,000 - self-funded drugs 30,000 - starting line 2,000 yuan) * 70% = 75,600 yuan (cross-city threshold doubled, the reimbursement ratio fell by 5%)
Step 2:
Secondary reimbursement of major illness insurance: (after deducting 30,000 self-funded drugs, it belongs to the total reimbursement range of 34,400 yuan for major illnesses, and then deducts 15,000 starting lines), the remaining 19,400 belongs to the scope of secondary reimbursement of social security major illnesses, according to the local grading policy, it can be reported 60%, 19400 * 60% = 11640 yuan
(Usually major illness insurance is also directly settled for discharge)
Mr. Liu spent 140,000 yuan on hospitalization, and the social security reported a total of 75,600 + 11,640 = 87,240 yuan
There are also 30,000 self-funded drugs and 22,760 yuan of reasonable social security costs that have not been reported.
Step 3:
Government assistance for serious diseases: For 22,760 yuan, if the patient meets the local major illness assistance targets, it can also be reimbursed by the government. Major illness assistance usually does not include out-of-pocket medicines outside the Health Insurance List (subject to specific local regulations).
Major illness assistance is actually for the remaining out-of-pocket part of the reimbursement of medical insurance pooled accounts, major illness insurance, special outpatient clinics, etc., and further assistance is carried out.
<h1 class="pgc-h-arrow-right" data-track="41" >2, give examples of major disease relief policies in some areas</h1>
In addition to the introduction of medical insurance management measures, each city will also introduce a major illness relief policy to further subsidize special groups and reduce the burden.
1. Xiamen Medical Aid Measures
Xiamen Medical Aid Recipients and Standards
The first type of assistance object: special hardship support personnel
Such persons refer to the elderly, disabled persons and minors under the age of 16 who are unable to work and have no source of income, and whose legal supporters and dependants do not have the ability to support and support them. Medical expenses are fully subsidized by the government and are not capped.
The second type of assistance objects: the minimum subsistence guarantee object, that is, the low-income household; in addition, special family members of family planning (the unfortunate death of the only child), the 1960s streamlined retirement relief object, the key preferential care object, the severely disabled, etc., can be reimbursed 95%, outpatient and inpatient assistance, capped at 30,000 and 100,000 respectively;
The third type of assistance object: low-income family members, reimbursement rate of 85%
The fourth type of assistance objects: participate in medical insurance, hold a disability certificate, but are not severely disabled; permanent residents due to illness expenditure; non-Xiamen household registration students, etc.; can also be reimbursed 75%, there is a 1500 yuan payment line, outpatient hospitalization can help up to 120,000;
The fifth type of assistance targets: occupational patients whose employers no longer exist or cannot confirm the labor relationship; retirees whose pension is less than 60% of the average salary of the previous year; retirees who participate in resident medical care and have local household registration for 5 years or more over the age of 70 can be reimbursed 50%, and the maximum assistance is 10,000 yuan.
2. Nanjing Municipal Medical Aid Measures
According to the "Nanjing Medical Assistance Measures" and the notice of adjustment, the recipients of assistance are divided into two categories, one is the person who is poor due to illness, and the other is the low-income household, the special hardship support person, the orphan, etc.:
Write at the end:
There is still a certain difference between the city's serious illness assistance object and the amount of assistance and the proportion of assistance, if you want to understand the medical assistance policy for serious illness where you are located, you can leave a message, I will reply one by one.