The State Medical Insurance Administration and The Ministry of Finance issued the notice about ensuring basic medical care for urban and rural residents in 2019, called for establishing a united medical system for urban and rural residents, as well as made an interpretation of the outpatient insurance policy on basic medical insurance for urban and rural residents.  

Before reading the key point, we’d better make clear the differences between the medical insurance for urban and rural residents as well as the medical insurance for urban staff.

The financing standard of the medical insurance for rural and urban residents as well as the severe illness insurance

The 2019 average financing standard of the medical insurance for urban and rural residents increases by 60 yuan, among which the financial subsidy standard increases by 30 yuan to reach no less than 520 yuan per person per year. Half of the increased financial subsidy will be used for strengthening the ability to guarantee severe illness insurance, i.e., increasing by 15 yuan based on the 2018 average financing standard. Meanwhile, the personal contributions will increase by 30 yuan to reach 520 yuan per person per year.

 Financing means paying an mount of money. As can be seen from figure-1, those who buy medical insurance for urban and rural residents need to pay by themselves.

As an urban resident, Xiaoming bought medical insurance for urban and rural residents. In 2018, Xiaoming only needs to pay 220 yuan per year, and the financial subsidy he can get is 490 yuan. But in 2019, Xiaoming needs to pay 250 yuan per year, and the financial subsidy he can get increases to 520 yuan. In a word, the 2019 average financing standard increases by 60 yuan totally.

The severe illness insurance, which is the abbreviation of the medical insurance for severe diseases of urban and rural residents, is the policy that bases on basic medical insurance and gives reimbursement for the urban and rural residents who spent much money on treating severe illness. The funds for severe illness insurance was transferred from medical insurance funds for urban and rural residents according to the financing standard. The 2018 financing standard is 30 yuan, which will be raised to 45 yuan this year with half of the new government financial subsidies.

Canceling personal (familial) accounts

personal (familial) accounts shall be canceled by the end of 2020 in areas where they are available now, so as to make a smooth transition to outpatient services. If the personal (familial) accounts have been canceled, it shall not be restored or set up in disguised form.

★★Canceling the personal (familial) accounts of medical insurance for urban and rural residents will not reduce the medical insurance benefits of residents, but will be replaced by promoting risk pooling of outpatient services. The personal (familial) accounts in the medical insurance for urban and rural residents will be canceled, while the personal (familial) accounts in the medical insurance for urban staff will be remained.

After promoting the risk pooling of outpatient services, the medical expenses of minor diseases could be included in the overall planning fund. Those who spend money on common disease or frequently encountered disease in basic medical institution, can apply for reimbursement and the proportion is around 50 percentage points. Meanwhile, in order to lessen the severe disease burden of insured residents, if the insured residents are treated for the chronic disease or special disease in clinic and cost much, their expenses will be included into the pooling funds and shall be managed and payed for by reference to the hospital.

The reimbursement rate is sixty percentage points

Include hypertension, diabetes and other outpatient diseases into the medical insurance reimbursement.

Lower and unify the minimum payment line for severe illness insurance, as well as increase the reimbursement rate within the scope of the police from 50% to 60%. Give greater priority to the poor in payment, i.e., removing the ceiling line from all areas based on lowering the minimum payment line by 50% and raising the payment rate by five percentage points.

Assuming the minimum payment line of the clinic in Zhuhai is 1000 yuan per year, Xaioming, who participates in medical insurance for urban and rural residents, spent 300 yuan totally in clinic this year, so the 300 yuan can only be paid by Xiaoming himself. If Xiaoming spent 1500 yuan totally in clinic this year, he shall bear 1000 yuan first, and the excess 500 yuan can be reimbursed according to the prescribed proportion.