National Medical Insurance Bureau: Starting next year, the financial subsidy will increase by 30 yuan. Two situations can enjoy insurance incentives
2024-08-26
한어Русский языкEnglishFrançaisIndonesianSanskrit日本語DeutschPortuguêsΕλληνικάespañolItalianoSuomalainenLatina
In order to thoroughly implement the spirit of the 20th CPC National Congress and the relevant tasks and requirements of the 2024 Government Work Report, further improve the basic medical insurance for urban and rural residents, continuously enhance the basic medical insurance capacity, and strive to relieve the people's worries about medical treatment, the National Health Insurance Administration, together with the Ministry of Finance and the State Administration of Taxation, issued the "Notice on Doing a Good Job in the Basic Medical Insurance for Urban and Rural Residents in 2024" (Medical Insurance [2024] No. 19), hereinafter referred to as the "Notice"). The relevant contents are interpreted as follows:How will the financing of residents’ medical insurance be arranged in 2024?
In order to actively adapt to the situation of growing life expectancy and continuous improvement in medical consumption, and to consolidate and improve the level of residents' medical insurance benefits, the "Notice" clearly stated that in 2024, the finances at all levels will continue to increase subsidies for residents' medical insurance participation and payment, and at the same time, the increase in residents' personal contributions will be appropriately reduced. The fiscal subsidy and personal contribution standards will increase by 30 yuan and 20 yuan respectively compared with the previous year, and each person will not be less than 670 yuan and 400 yuan per year respectively. This is the first time since 2016 that the new personal contribution standard has been lower than the fiscal subsidy standard. It should be noted that, against the background of growing life expectancy and continuous improvement in medical consumption, it is an objective need to reasonably increase personal contributions and fiscal subsidy standards to consolidate and improve the level of benefits and ensure the smooth operation of the system. In addition, the "Notice" also requires the simultaneous optimization of the financing structure of serious illness insurance, emphasizing that fiscal subsidies at all levels should be allocated in full and in a timely manner in accordance with regulations, and shall not be squeezed or misappropriated.What are the specific requirements for residents’ medical insurance benefits in 2024?
In order to effectively enhance the sense of gain of the masses in participating in the insurance, the "Notice" clearly requires the steady improvement of the level of basic medical insurance, the enhancement of the precise protection capacity of major disease insurance, and the strengthening of the protection of medical expenses for childbirth under the residents' medical insurance. First, continue to consolidate the level of hospitalization benefits, steadily improve the level of outpatient protection, and comprehensively promote the implementation of the family mutual aid policy of personal accounts of employee medical insurance. Second, reasonably determine the deductible standard, reimbursement ratio and maximum payment limit of major disease insurance, and improve the accuracy of protection of high medical expenses for patients with major diseases. Third, include prenatal examination fees in outpatient protection, and reasonably improve the level of protection for medical expenses for hospitalization, childbirth and childbirth. The "Notice" particularly emphasizes the promotion of standardized and unified systems and policies, requiring all provinces to organize a "look back" on the three-year action plan for the list of medical insurance benefits, actively and steadily promote the provincial-level coordination of basic medical insurance, explore incentive and constraint measures for continuous insurance in accordance with the direction clearly defined by the state, and gradually unify the centralized collection period.How can we do a solid job in consolidating the achievements of the medical insurance poverty alleviation campaign in the second half of the transition period?
The "Notice" requires the implementation of comprehensive medical insurance assistance policies, the establishment of a long-term mechanism to prevent and resolve poverty due to illness, and the work of enrolling low-income rural populations and people who have been lifted out of poverty in insurance, ensuring that the insurance rate of these two types of people is not less than 99%.First,Implement the medical assistance classification subsidy policy in accordance with regulations. Regions with conditions can moderately increase the quota subsidy standards and increase preferential assistance efforts based on actual conditions.Second,Regularly carry out monitoring and early warning of patients burdened with high medical expenses, further strengthen information sharing and inter-departmental coordination, and actively guide social forces such as charities to participate in relief and protection.What are the incentives to encourage residents to continue participating in insurance and paying premiums?
Recently, the General Office of the State Council issued the "Guiding Opinions on Improving the Long-term Mechanism for Participation in Basic Medical Insurance", which clearly proposed to establish an incentive mechanism for serious illness insurance benefits for continuous residents' medical insurance participants and zero reimbursement participants. 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. The continuous insurance incentive is to participate in insurance for 4 consecutive years. After that, you can enjoy the continuous insurance incentive for each consecutive year of insurance, and increase the maximum payment limit of serious illness insurance in accordance with regulations; the zero reimbursement incentive is zero reimbursement of the fund in the current year, and you can enjoy the incentive in the next year, and increase the maximum payment limit of serious illness insurance in accordance with regulations. The two measures are set up independently and will be implemented from 2025. For those who meet the incentive conditions, the maximum payment limit of serious illness insurance will be increased, and each increase will not be less than 1,000 yuan, which is much higher than the 400 yuan paid by individuals. If a serious illness reimbursement occurs in the current year and the zero reimbursement reward amount is used, although the zero reimbursement incentive amount is recalculated in the second year, it will not affect the continuous insurance incentive. For continuous insurance incentives, even if the insured resident stops the insurance, the continuous insurance years will be recalculated, but the continuous insurance incentive amount will be retained. Through incentives, insured residents are encouraged to strengthen their own health management and continue to pay insurance premiums. Continuous insured persons can obtain higher protection, which fundamentally protects the interests of all insured persons and ensures the smooth operation of the fund.How to improve people’s sense of gain by incorporating village clinics into medical insurance designated management?
As the most basic medical institution, the village clinic is the foundation of the rural medical and health service system, the first stop for rural residents to see a doctor, and the "last mile" to achieve medical security services. Including village clinics in the designated medical insurance management is of great significance to continuously meet the growing medical security needs of rural people and improve the accessibility of medical treatment and medicine for common and frequently occurring diseases. Recently, the National Medical Insurance Administration, together with the National Health Commission, issued the "Notice on Accelerating the Promotion of the Inclusion of Village Clinics in the Designated Medical Insurance Management", guiding all localities to accelerate the inclusion of village clinics in the designated medical insurance management in accordance with the principle of "creating conditions, optimizing processes, strengthening scheduling, and including as many as possible", ensuring that eligible village clinics will be included in the medical insurance settlement scope in a timely manner before the end of 2024, and that administrative villages with multiple village clinics will ensure that at least one village clinic is included in the designated medical insurance management, ensuring that medical insurance services are "accessible to every village", and facilitating people to seek medical treatment and purchase medicine at their doorsteps. Support village doctors to carry out family doctor contracting services, carry out door-to-door inspections, preventive health care, chronic disease management, and traditional Chinese medicine diagnosis and treatment services for participation in insurance mobilization. As of April 2024, there are 580,000 village clinics in normal operation across the country, of which 100,000 are included in the scope of independent medical insurance designation, and another 320,000 village clinics adopt the "rural integration" management model and realize medical insurance reimbursement through township health centers. More than 72% of village clinics across the country have been included in the medical insurance payment scope.Can the personal accounts of employees’ medical insurance be shared with family members participating in urban and rural residents’ medical insurance?
"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" recently issued by the General Office of the State Council clearly stated that the mutual aid scope of employee medical insurance personal accounts will be expanded to close relatives. Among them, close relatives refer to spouses, parents, children, brothers and sisters, grandparents, grandparents, grandchildren, and grandchildren as stipulated in the "Civil Code". Employee medical insurance personal accounts can be used to pay the personal contributions of close relatives to participate in resident medical insurance. Close relatives participating in basic medical insurance can also use the personal accounts of related employee medical insurance participants to settle when reimbursing medical expenses. The "Notice" requires the comprehensive promotion of the implementation of the policy on family mutual aid use of employee medical insurance personal accounts. The National Medical Insurance 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 order to effectively organize and implement the policy, the "Notice" requires all localities and relevant departments to strengthen organizational leadership, improve work mechanisms, consolidate work responsibilities, strengthen departmental coordination, enhance risk awareness, strengthen fund management, do a good job in publicity and interpretation, and promote the implementation of systems and policies in detail and effectively safeguard the medical insurance rights and interests of the people.Chinese medical insurance, lifelong protection! If this article is helpful to you, please share it with your family and friends!
