1, the recipients who enjoy the regular quantitative living allowance from the civil affairs department of this Municipality;
2, the city's urban and rural low-income family members and scattered orphans;
3. Urban low-income family members;
4, the city's poor family members due to illness;
5, approved by the municipal government and other objects that meet the conditions of medical assistance.
Second, the application materials
Materials to be provided for three types of objects (subsistence allowances, five-guarantee households and poor households):
1. The applicant shall provide himself (the head of household) and a copy of the patient's ID card and household registration book (description of the copy of household registration book: the information of the head of household's home page is copied on a piece of paper with information of all family members on it).
2 provide copies of relevant certificates (such as subsistence allowances, five guarantees, poverty alleviation certificates, disability certificates, chronic disease certificates, etc.). ) (Note: Patients with poor households who set up a file and set up a card must print the information collection form of poor households, indicate when they are included in poor households and whether they are still enjoying poverty alleviation policies, and sign and seal it).
3. Discharge settlement list (original must be provided) and invoice.
4. Proof of disease diagnosis (original must be provided).
5. Provide a copy of the patient's rural credit cooperative one-card passbook (or card) (it must be a one-card card). If the copy of the one-card passbook (or card) of the rural credit cooperative is not a patient, it must go to the village Committee to prove the relationship and sign and seal it. (Reference template for relationship proof)
6, rescue approval form in duplicate.
Third, the application process
The applicant shall submit an application to the Township People's Government and the sub-district office, and after examination and publicity, it shall be approved by the civil affairs department of the people's government at the county level. Medical assistance for family members of the minimum living guarantee and destitute dependents shall be directly handled by the civil affairs department of the people's government at the county level. The specific application process is implemented according to local policies.
How soon will the money for medical assistance arrive?
Medical assistance provided by civil affairs departments is generally reimbursed twice a year, once in the first half and once in the second half.
Where is the money for medical assistance?
Just type the applicant's passbook in the rural credit cooperative and pick it up after 3 months. Cards from other banks refused to pay.
How much is medical assistance generally?
Social security medical assistance, that is, medical assistance for serious illness, is used to pay the hospitalization medical expenses above the maximum payment limit of the basic medical insurance pooling fund of the insured. The medical assistance expenses are as follows:
(1) The deductible line is 8,000 yuan: excluding the out-of-pocket expenses of individuals below the deductible line of basic medical insurance, it should include the allowance for civil special care recipients and the amount of medical assistance for poor patients. The personal burden of low-income households, entitled groups and rural five-guarantee households that are lower than the basic medical insurance reimbursement deductible standard for each hospitalization is included in the serious illness reimbursement deductible standard. The deductible of 8000 yuan is an annual deductible, which can only be deducted once a year.
(2) The compensation standard adopts the method of "subsection proportion, from low to high, and progressive compensation": subsection proportion is 50%, 60%, and 70%, of which: 50% is paid for 8,000 yuan to 30,000 yuan (inclusive), 60% is paid for 30,000 yuan to 50,000 yuan (inclusive), and 70% is paid for more than 50,000 yuan.
(3) Not included in the reimbursement scope of serious illness insurance: Medical expenses incurred in non-designated medical institutions in the province and non-public hospitals outside the province are not included in the reimbursement scope of serious illness insurance. The medical expenses incurred in the abnormal referral of medical institutions in the province and in public hospitals outside the province shall be included in the calculation of serious illness insurance self-sufficiency and compliance medical expenses according to the proportion of 60% after the basic medical insurance is reimbursed according to relevant policies.
(4) Maximum reimbursement amount of serious illness insurance: The maximum annual payment amount of serious illness insurance is 500,000 yuan per person per year.
(5) Accidental injury and traffic accident self-injury without the responsibility of a third party. After compensation by the basic medical insurance fund, the eligible out-of-pocket expenses are fully included in the coverage of serious illness insurance; After compensation by the basic medical insurance fund, the cost of large-scale materials implanted in the body within 30 thousand yuan will be fully included in the scope of serious illness insurance, and the part exceeding 30 thousand yuan will not be compensated. The above-mentioned compliance expenses of insured urban residents are included in the scope of serious illness insurance according to the existing relevant policies.
Proportion of reimbursement for serious illness relief in civil affairs
The main relief targets of civil serious illness relief are key entitled groups, the wounded who are courageous, the urban and rural subsistence allowances, the rural five-guarantee recipients, the orphans scattered in society, the people with difficulties in low-income families and other people with difficulties identified by the district and county people's governments. Among them, the scope of serious illness relief mainly includes congenital heart disease in children, leukemia in children, uremia, breast cancer, esophageal cancer, colon cancer, lung cancer, gastric cancer, rectal cancer, acute myocardial infarction, hemophilia, drug-resistant tuberculosis, radiotherapy and chemotherapy of malignant tumor, opportunistic infection of AIDS, severe psychosis, chronic myeloid leukemia, cerebral infarction, type 2 diabetes, hyperthyroidism, cleft lip and palate, renal dialysis and taking anti-rejection drugs after organ transplantation.
As for the proportion of civil serious illness assistance, according to the different levels of medical institutions, the proportion of reimbursement will be different. Details are as follows:
1. The proportion of civil serious illness assistance can be increased to 65% and 75% by coordinating township and village clinics;
2. There is no deductible standard for hospitalization expenses below 400 yuan in a medical institution;
3, in the secondary medical institutions for medical treatment, the proportion of civil serious illness relief can be increased to 75%-80%;
4, in the tertiary medical institutions, the proportion of civil serious illness relief can be increased to 55%-60%;
5, hospitalized in the provincial tertiary medical institutions, the proportion of civil serious illness relief can be increased to 55%;
6, congenital heart disease in children, childhood leukemia and other eight serious diseases of the new rural cooperative medical subsidy disease quota of 70%, lung cancer, esophageal cancer, colon cancer and other 12 serious diseases of the new rural cooperative medical subsidy disease quota strive to reach 70%.
To sum up, the proportion of civil serious illness assistance in different medical institutions will be different, and the proportion of reimbursement will be different. So much for the above introduction. I hope I can help you.
Reply to related questions
First, what is the use of large medical assistance?
A: Large mutual assistance is reimbursed by the general outpatient department. In the case of special outpatient service and hospitalization, large-scale mutual aid reimbursement is the expenses exceeding the reimbursement ceiling line of the overall fund within one year, and the deductible line of ordinary outpatient service is 2000 (equivalent to deductible), and the expenses above 2000 can be reported as 50%, with a maximum of 20,000. Reimbursement for special outpatient service and hospitalization is the part where the expenses exceed the ceiling line of the overall fund (70,000), and it is reported as 70%, with a maximum of 65,438+10,000.
Second, what is the difference between temporary civil assistance and urban and rural Medicaid?
Answer: 1. Temporary assistance standard
Temporary assistance focuses on the following situations in view of the sudden special difficulties encountered in the family life of the target group:
(1) Temporary assistance of 500-800 yuan can be given to those who have difficulties in life due to illness;
(2) Temporary assistance of 500- 1000 yuan can be given to children from poor families who study full-time at school;
(3) If family life is difficult due to other reasons, temporary assistance of 300-500 yuan can be given.
2. The urban and rural medical assistance system refers to the assistance system that establishes funds through multi-channel financing such as government grants and social donations, and gives medical expenses subsidies to rural five-guarantee households and poor peasant families who are seriously ill, those who have not participated in the basic medical insurance for urban workers, those who have participated in the basic medical insurance for urban workers but still have a heavy personal burden, and other people with special difficulties (rural medical assistance can also fund the recipients to participate in the local new rural cooperative medical care).
Third, can rural medical assistance subsidize the New Year?
A: Yes. The insured households will submit the materials required for reimbursement to the village (community) cooperative medical liaison, who will be the village (community) cooperative medical liaison.