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On August 26, the National Healthcare Security Administration and three other departments issued the "Notice on Doing a Good Job in Basic Medical Insurance for Urban and Rural Residents in 2024" (hereinafter referred to as the "Notice").

The Notice clearly states that the level of benefits for urban and rural residents' basic medical insurance (hereinafter referred to as "resident medical insurance") will be increased, with fiscal subsidies and individual payment standards increasing by 30 yuan and 20 yuan respectively from the previous year, and no less than 670 yuan and 400 yuan per person per year respectively. The reporter noted that this is the first time since 2016 that the additional individual payment standard has been lower than the fiscal subsidy standard.

In terms of consolidating and improving the level of medical insurance benefits, the level of basic medical insurance will be steadily improved, the level of hospitalization insurance will continue to be consolidated, and the fund payment ratio within the policy scope will be stabilized at around 70%. The precision protection capability of major disease insurance will be enhanced, and the maximum payment limit of residents' medical insurance superimposed on major disease insurance will in principle reach about 6 times the per capita disposable income of urban and rural residents in the previous year, and the reimbursement ratio will be tilted towards high medical expenses.

The financial subsidy and personal payment standards will increase by 30 yuan and 20 yuan respectively.

The "Notice" proposes that in 2024, finance at all levels will continue to increase subsidies for residents' medical insurance participation and premiums. At the same time, the growth rate of residents' personal contributions will be appropriately reduced. The financial subsidies and personal contribution standards will increase by 30 yuan and 20 yuan respectively compared with the previous year, reaching no less than 670 yuan and 400 yuan per person per year.

The reporter noted that this is the first time since 2016 that the new individual payment standard is lower than the fiscal subsidy standard. "Against the background of the continuous increase in life expectancy and the continuous improvement in medical consumption, it is an objective need to reasonably increase the individual payment and fiscal subsidy standards to consolidate and improve the treatment level and ensure the smooth operation of the system," said a relevant person in charge of the National Health Insurance Administration.

To ensure that financial subsidies are timely and in full, the Notice clarifies that the central government will continue to implement tiered subsidies to local governments in accordance with regulations, providing subsidies to the western and central regions at a rate of 80% and 60% of the per capita financial subsidy standards, respectively, and to the eastern provinces at a certain rate. To further implement the policy of participating in the insurance with residence permits, the finances at all levels should provide subsidies to local residents who participate in the local resident medical insurance with residence permits at the same rate as local residents.

At the same time, the "Notice" also requires the simultaneous optimization of the financing structure of serious illness insurance, emphasizing that financial subsidies at all levels must be allocated in a timely and full manner in accordance with regulations, and must not be squeezed or misappropriated.

In addition, in terms of optimizing the financing structure of serious illness insurance, the Opinions emphasizes the need to coordinate the arrangement and use of residents' basic medical insurance and serious illness insurance funds, and to reasonably determine the level of serious illness insurance financing in light of factors such as the level of local economic development, the medical expenses of serious illnesses, and the fund's support capacity. Explore the establishment of a sustainable dynamic adjustment mechanism for serious illness insurance financing. Explore ways to broaden the financing channels for serious illness insurance and optimize the financing structure.

The reimbursement ratio of residents' medical insurance is tilted towards high medical expenses

In order to effectively enhance the people's sense of gain from participating in the insurance, the "Notice" clearly states that the level of basic medical insurance should be steadily improved. The level of hospitalization insurance should continue to be consolidated, and the fund payment ratio within the policy scope should be stabilized at around 70%. Coordination areas with conditions can steadily improve the level of outpatient insurance according to the level of economic and social development and the fund's affordability, continue to tilt towards grassroots medical institutions, and guide the masses to seek medical treatment at the grassroots level. Continue to improve the outpatient medication guarantee mechanism for hypertension and diabetes in urban and rural residents. Comprehensively promote the implementation of the policy of family mutual use of personal accounts of basic medical insurance for employees.

"Family mutual aid can participate in insurance, helping the elderly and the young." The "Guiding Opinions on Improving the Long-term Mechanism for Participation in Basic Medical Insurance" (hereinafter referred to as the "Opinions") recently issued by the General Office of the State Council clearly stated that the scope of mutual aid in the personal accounts of employee medical insurance will be expanded to close relatives. According to the provisions of the Civil Code, close relatives include spouses, parents, children, brothers and sisters, grandparents, grandchildren, and grandchildren.

A relevant official from the National Healthcare Security Administration said that in order to fully promote the implementation of the policy on family mutual aid use of employee medical insurance personal accounts, the National Healthcare Security Administration will actively promote the further expansion of the geographical scope of mutual aid, strive to achieve mutual aid within all provinces before the end of this year, and accelerate the promotion of cross-provincial mutual aid next year.

In terms of enhancing the precise protection capabilities of serious illness insurance, the "Notice" points out that based on factors such as the level of serious illness insurance funding and the protection needs of serious illness patients, the serious illness insurance deductible, reimbursement ratio, and maximum payment limit should be reasonably determined to improve the accuracy of serious illness insurance in protecting against the high medical expenses of serious illness patients.

At the same time, the deductible for serious illness insurance shall not be higher than the per capita disposable income of urban and rural residents in the previous year in principle. The maximum payment limit for the combination of residents' medical insurance and serious illness insurance shall, in principle, reach about 6 times the per capita disposable income of urban and rural residents in the previous year in the local area, and the reimbursement ratio shall be tilted towards high medical expenses.

In addition, the Notice requires all provinces to set up corresponding incentive measures for continuous insured persons in accordance with the clear direction of the state and strictly implement them. All provinces guide the coordinated regions to gradually unify the centralized collection period and generally complete the 2025 resident medical insurance enrollment and payment work by the end of February 2025.

According to the Opinion, an incentive mechanism for serious illness insurance benefits will be established for residents who have been continuously insured and have zero reimbursement. The continuous insurance incentive is for continuous insurance for 4 years, and for each consecutive year thereafter, the continuous insurance incentive can be enjoyed, and the maximum payment limit of serious illness insurance will be increased according to regulations; the zero reimbursement incentive is for zero reimbursement of the fund in the current year, and the incentive can be enjoyed in the next year, and the maximum payment limit of serious illness insurance will be increased according to regulations.

A relevant official from the National Healthcare Security Administration said that incentive measures will be used to encourage residents participating in medical insurance to strengthen their self-health management and continue to participate in insurance and pay premiums. Continuously insured persons can obtain higher protection, and the interests of all participants will be better protected fundamentally, while ensuring the smooth operation of the fund.