There will be big changes in medical insurance!

A few days ago, the General Office of the State Council issued the "Guiding Opinions on Improving the Long-term Mechanism of Basic Medical Insurance". How does the mainland's first long-term mechanism for basic medical insurance operation work? Let's look at it together –

It is more convenient for these groups to enroll in medical care

newborn

Promote the implementation of the integrated handling of "one thing at birth" such as birth medical certificates, household registration, medical insurance participation, and social security card applications, simplify procedures, optimize processes, and promote guardians to participate in insurance for newborns in the year of birth.

minor

Megacities and megacities should earnestly implement the policy of holding residence permits to participate in insurance, and promote primary and secondary school students and preschool children with household registration in other places of residence to participate in resident medical insurance.

university student

Encourage college students to participate in resident medical insurance in their place of residence, implement relevant policies for insurance participation, and do a good job in expanding the coverage of college students' participation in resident medical insurance.

Flexible employment personnel, migrant workers, and new forms of employment

● Megacities should abolish the household registration restrictions on flexible employees, migrant workers, and new forms of employment to participate in basic medical insurance at the place of employment, and do a good job in participating in employee medical insurance at the place of employment.

● Adapt to the diversification of employment forms, and study and improve the insurance payment methods for flexibly employed persons.

Rural dwellers

Voluntary applications and eligible village clinics will be included in the scope of medical insurance settlement, and real-time settlement will be promoted. Promote the rational allocation of national centralized procurement of drugs in village clinics, facilitate rural residents to seek medical treatment nearby, and better promote hierarchical diagnosis and treatment.

There is good news for these groups to enroll

worker

Support the personal account of employee medical insurance to pay for the personal payment of the close relatives of the insured personnel to participate in the resident medical insurance and the personal medical expenses incurred by the close relatives who have been insured in the designated medical institutions for medical treatment and drug purchase.

Unemployed

Implement the policy of paying the medical insurance (including maternity insurance) premiums for employees who receive unemployment insurance money from the unemployment insurance fund, and ensure that they enjoy the same medical insurance and maternity insurance benefits as insured employees.

Difficult people

Persons in extreme poverty, recipients of minimum livelihood guarantees, and eligible targets for monitoring the prevention of returning to poverty are to be given categorical subsidies in accordance with relevant provisions.

Persons who are continuously insured by resident medical insurance and those who have zero reimbursement

● For those who have participated in the resident medical insurance for 4 consecutive years, the maximum payment limit of the critical illness insurance can be appropriately increased for each consecutive year after that.

● For those who have zero reimbursement from the fund in the current year, the maximum payment limit of critical illness insurance can be increased in the following year.

● In principle, the limit of continuous insurance participation and zero reimbursement incentive shall not be less than 1,000 yuan each time, and the cumulative total increase shall not exceed 20% of the original cap line of critical illness insurance in the overall planning area. After the resident is reimbursed for serious illness and the reward amount is used, the zero reimbursement incentive amount accumulated in the previous period will be cleared.

There are changes in the participation of these groups

People who are re-insured and have not enrolled in insurance on time

● From 2025 onwards, the maximum payment limit of critical illness insurance can be reduced for those who have re-enrolled in the insurance.

● If the insurance is re-insured after the insurance is terminated, the number of consecutive years of insurance will be recalculated. The specific policy standards shall be determined by each province according to the actual situation such as the affordability of the medical insurance fund.

● From 2025, except for special groups such as newborns, for those who have not participated in the insurance or have not been continuously insured during the centralized insurance period of resident medical insurance, a waiting period of 3 months will be set for fixed treatment after enrollment; Among them, if the insurance is not continuously insured, for every additional 1 year, in principle, the waiting period for change of treatment will be increased by 1 month on the basis of the fixed treatment waiting period, and the insured person can repair the waiting period for change of treatment by paying premiums, and the waiting period for change of treatment can be reduced by 1 month for every additional year, and if the payment is interrupted for 4 years or more, the sum of the waiting period for fixed treatment and the waiting period for change of treatment after repair shall not be less than 6 months in principle.

● The payment shall refer to the individual payment standard of the insured place in the current year. The specific standard of the waiting period is determined by each province according to its own situation.