Chapter one? Total? rule

Rule number one In order to further reduce the burden of medical expenses of poor workers and urban and rural residents, prevent the risk of returning to poverty due to illness, and build the bottom line of people's livelihood security, according to the Opinions of the General Office of the State Council on Improving the Medical Insurance Assistance System for Serious and Extraordinary Diseases (Guo Ban Fa [2021] No.42) and the Implementation Opinions of the General Office of Sichuan Provincial People's Government on Improving the Medical Insurance Assistance System for Serious and Extraordinary Diseases (Chuan Ban Fa [2022])

Rule number two The medical insurance assistance system for serious and serious diseases follows the following principles:

(a) adhere to the basic, do your best, do what you can, and the level of assistance is compatible with economic and social development.

(2) Strengthen the comprehensive protection of basic medical insurance, serious illness insurance and medical assistance (hereinafter referred to as the triple system), focus on reducing the burden of serious illness medical expenses for employees with difficulties and urban and rural residents, form a joint force of systems, and realize efficient linkage and benign interaction.

(three) to establish a unified medical assistance system in the city, and fully realize the municipal overall planning of medical assistance. The city's unified rescue scope, unified funds, unified rescue methods, unified rescue standards, unified fund management and unified settlement methods.

(4) Optimize the rescue process, standardize the settlement procedures, and realize the "one-stop" and "one-stop" settlement of medical assistance and basic medical insurance, serious illness insurance, various supplementary medical insurance and commercial health insurance, so as to ensure that employees and urban and rural residents with difficulties can receive timely and effective assistance.

Rule three. The Municipal Medical Security Bureau is the competent department of medical assistance in the whole city, and the Social Affairs Bureau of Meishan Administrative Committee of Tianfu New District and the County (District) Medical Security Bureau are the competent departments of medical assistance in this area. City, county (District) two levels of medical security agencies in accordance with the division of responsibilities to do a good job in business handling.

Chapter two? Rescue object and identification

Article 4? The target of assistance. Medical assistance covers employees and urban and rural residents with heavy medical expenses fairly, and classified assistance is implemented according to the categories of recipients.

(1) destitute personnel;

(2) orphans;

(3) Minimum target;

(4) Marginal family members;

(five) the rural population that is easy to return to poverty and leads to poverty (hereinafter referred to as the monitoring object of returning to poverty) will be included in the monitoring scope;

(VI) Seriously ill patients (hereinafter referred to as poverty-stricken and seriously ill patients due to illness) who do not meet the aid and support conditions for destitute people, low-income or low-income marginal families, but have serious difficulties in family basic life due to high medical expenses.

Other persons with special difficulties as stipulated by the local people's governments at or above the county level shall be given corresponding assistance according to the above categories of assistance objects.

Article 5? Poverty-stricken people, orphans, subsistence allowances, marginal family members and seriously ill patients caused by illness are identified by the civil affairs department, and the monitoring objects for preventing poverty return are identified by the rural revitalization department.

Chapter three? Ways and standards of assistance

Article 6? Classified subsidy insurance

After the needy people participate in the basic medical insurance according to law, they enjoy the rights and interests guaranteed by the triple system according to regulations. For those who have difficulties in achieving stable employment, guide them to participate in the basic medical insurance for employees according to the law and regulations. We will fully implement the financial subsidy policy for basic medical insurance for urban and rural residents. For the individual contributions to participate in the basic medical insurance for urban and rural residents, the poverty-stricken people and orphans will be fully subsidized, and 75% of the minimum living security objects and the monitoring objects for poverty prevention will be given a fixed subsidy. The specific financing standard is announced by the Municipal Medical Security Bureau during the annual payment period of urban and rural residents' centralized insurance.

Article 7? Medical expenses assistance

(a) the scope of protection of the salvage expenses. Strictly implement the medical security treatment list system,

The drugs, medical consumables and diagnosis and treatment items paid by the medical assistance fund shall conform to the provisions of the scope of payment of basic medical insurance. The assistance expenses mainly cover the hospitalization expenses incurred by the aid recipients in designated medical institutions, the expenses for long-term medication due to chronic diseases or long-term outpatient treatment due to serious diseases, and the single-line payment expenses for drugs and high-value drugs. Personal out-of-pocket expenses within the following policies of basic medical insurance and critical illness insurance deductible line shall be included in the rescue guarantee according to regulations. Unless otherwise stipulated by the state and the province, it is not allowed to expand the scope of medical assistance expenses by itself or in a flexible way.

(2) Minimum payment standard for assistance. According to the degree of family difficulties of the relief object, the annual relief Qifubiaozhun (hereinafter referred to as Qifubiaozhun) is set according to the classification.

1. completely abolish the minimum payment standard for destitute people, orphans and low-income residents;

2. Qifubiaozhun for poverty prevention monitoring objects is determined by 5% of the per capita disposable income of residents in our city last year;

3. Qifubiaozhun for marginal family members is determined according to 10% of the per capita disposable income of residents in our city last year;

4. Qifubiaozhun for patients with poverty and serious illness due to illness is determined according to 25% of the per capita disposable income of residents in our city last year.

Co-ordinate outpatient chronic diseases, outpatient serious diseases (hereinafter referred to as outpatient chronic diseases) and hospitalization assistance, calculate Qifubiaozhun based on outpatient chronic diseases and hospitalization medical expenses, and use the annual assistance limit. The annual specific relief Qifubiaozhun was announced by the Municipal Medical Security Bureau.

(3) the proportion and limit of assistance. If the medical expenses paid by individuals within the scope of the policy of assistance object exceed the Qifubiaozhun, assistance shall be given in proportion within the annual assistance limit.

1. Give full assistance to destitute people and orphans, with no annual assistance limit;

2. According to the proportion of 70% of the minimum living guarantee, the annual relief limit is 40,000 yuan;

3 poverty prevention monitoring object according to the proportion of 65% relief, the annual relief limit of 30 thousand yuan;

4 for marginal family members, poor and seriously ill patients due to illness, the proportion of assistance is 50%, and the annual assistance limit is 20 thousand yuan.

(4) Inclined rescue. After standardizing the referral for medical treatment in the province and the comprehensive guarantee of the triple system, if the accumulated annual out-of-pocket expenses of individuals within the policy scope still exceed the income standard for poverty prevention in our city, the proportion of assistance is 50%, and the annual assistance limit is 20,000 yuan.

Article 8? For the relief objects with multiple special identity attributes, they shall be included in the scope of relief according to the principle of "high is not low", and repeated relief shall not be allowed.

Article 9? Qifubiaozhun, proportion and annual relief limit of medical expenses assistance can be dynamically adjusted by the Municipal Medical Security Bureau according to the level of economic and social development, people's health needs and the support capacity of medical assistance funds.