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Notice of Opinions on Improvement of Relevant Policies Pertaining to the Basic Medical Insurances for Urban and Rural Residents

To People’s Governments of all counties and districts, departments of the Municipal People’s Government and the Direct Affiliated Institutions,

The Notice of Opinions on Improvement of Relevant Policies Pertaining to the Basic Medical Insurances for Urban and Rural Residents has been discussed and adopted by the municipal government. And now it is to send to you, please carry out it carefully and earnestly.


Notice of Opinions on Improvement of Relevant Policies Pertaining to the Basic Medical Insurances for Urban and Rural Residents

Since the startup of the work on basic medial insurance insurances for urban and rural residents, the operation thereof has been in a good condition and has basically achieved the target of “healing ailments on time, preventing chronic diseases on time and treating severe diseases on time”, which has been praised by the Ministry of Labor and Social Security and the provincial Department of Labor and Social Security and appreciated by the mass residents who have participated in the insurances. In order to push on the work more effectively, the policy on basic medical insurances for urban residents has been adjusted as follows:

1. The reimbursement proportion of 50% for each medical consultation at common outpatient department shall be adjusted to 100% of the actual payable medical fees within the scope of medical coverage until the running out of the subsidy.

2. As for the reimbursement of outpatient service, it is no longer to consider the fees paid in advance by individuals, and the medicine and the item contents for diagnosis and treatment within the scope of medical coverage shall be reimbursed at a proportion of 100%.

3. The reimbursement on inpatient service fees shall be divided based on such three grades of hospitals as Grade I, Grade II and Grade III. The hospitals at towns and medical service centers which have not been rated shall execute the medical coverage standard in accordance with the standard applicable to the Grade I medical institutions.

4. According to the different grades (Grade I, II and III) of the hospitals, the basic payments for inpatient service are classified into: 100 Yuan for Grade I, 200 Yuan for Grade II and 400 Yuan for Grade III (including non-designated hospitals).

5. Increase the reimbursement proportion on subsidies for hospitalization: 75% shall be reimbursed at Grade I medical institutions, 65% reimbursed at Grade II medical institutions; 55reimbursed at Grade III medical institutions; 35% at non-designated medical institutions; and the maximum amount limit for the hospitalization payment has been increased to 25 thousand Yuan for adults and 35 thousand Yuan for minors.

6. Bring the fees for one-off delivery and payments for the postpartum complication of the insured female residents who conform to the national family plan policy into the scope of medical aid for hospitalization. And set the maximum payment limit, with the specific standard as: 500 Yuan for nature delivery and 800 Yuan for abdominal delivery.

7. Cancel the basic payment standard for special diseases, increase the proportion of payment for special diseases at outpatient departments; and cancel the different payment proportions at different grades of hospitals, and set a unified proportion of payment for special diseases, with a specific standard of 50%.

8. Set different payment limit according to different diseases, 800 Yuan for the maximum payment limit for single disease and 2000 Yuan for the maximum payment limit for two or above diseases.

The special diseases shall be executed subject to the Special Diseases Covered in the Basic Medical Insurance for Urban Staff and Workers in Nanchang City. The special diseases include: malignant tumor, cerebral infarction, cerebral thrombosis, cerebral apoplexy, all kinds of heart diseases combining with cardiac functional insufficiency (Grade II or above), hyperpiesia Stage II, diabetes Type II, aged asthmatic bronchitis, chronic viral hepatitis, pulmonary tuberculosis, psychosis, hemophilia, severe Parkinson's disease and nephritic syndrome.

9. Bring such diseases as hemodialysis, peritoneal dialysis, uremia and drug therapy against rejection after transplant surgery into the scope of special diseases at the outpatient departments.

10. The insured residents can freely choose outpatient departments at the designated community health service medicals within local districts and counties.

11. Adjust