明年我省(山东)农民可享大病保险 In our province next year(shandong)Farmers can enjoy a serious illness insurance

20种大病纳入首批保险范围，个人最高补偿20万元 20 kinds of serious illness in the first batch of insurance coverage,Personal highest compensation 200000 yuan

　　2013年，我省农民大病返贫将大幅减少。17日，省政府决定开展新农合大病医疗保险工作。自2013年1月1日起，大病保险资金将在新农合报销的基础上，对纳入保险范围的大病参保患者再次给予保障，实际支付比例将不低于50%，个人最高年补偿额达20万元。首批20种大病被纳入大病保险范围。

In 2013,,Our province farmers a serious illness will sharply reduce poverty.17,The provincial government decided to carry out the new agriculture joint medical treatment of a serious illness insurance work.Since January 1, 2013,A serious illness insurance funds will be in the new agriculture on the basis of close to submit an expense account,To into the insurance range of serious illness ginseng protect patients again give security,The actual payment ratio will not be less than 50%,Personal highest annual compensation amounted to 200000 yuan.The first batch of 20 kinds of serious illness was incorporated into a serious illness insurance coverage.

保险范围 Insurance coverage

儿童白血病心肌梗塞等纳入 Childhood leukemia myocardial infarction, etc into

　　17日，根据国家发改委等部委《关于开展城乡居民大病保险工作的指导意见》，省政府正式印发《山东省人民政府办公厅关于开展新型农村合作医疗重大疾病医疗保险工作的意见(试行)》，决定在全省开展新农合重大疾病医疗保险工作。

17,According to the national development and reform commission, and other ministries and commissions[About urban and rural residents to carry out a serious illness insurance work guiding opinions],Issued by the provincial government official[Shandong province people's government office about to carry out the new rural cooperative medical major disease medical insurance work opinion(trial)],In the province to carry out the new agriculture close major disease medical insurance work.

　　意见规定，在新农合政策范围内报销基础上，大病保险主要在参合居民患大病发生高额医疗费用的情况下，对新农合补偿后需个人负担的合规医疗费用给予保障。其中，高额医疗费用以上一年度全省农村居民人均纯收入作为判定标准。　　2013年，我省先将严重危害群众健康和影响农民生产生活，且疗效确切、费用易于控制的20类重大疾病纳入大病保险保障范围，包括：儿童白血病、儿童先天性心脏病、终末期肾病、乳腺癌、宫颈癌、重性精神疾病、艾滋病机会性感染、耐多药肺结核、血友病、慢性粒细胞白血病、唇腭裂、肺癌、食道癌、胃癌、I型糖尿病、甲亢、急性心肌梗塞、脑梗死、结肠癌、直肠癌等。

Opinion provisions,In the new agriculture joint policy based on the range to submit an expense account,A serious illness insurance mainly in the ginseng adds up to residents suffer from a serious illness happen under the condition of high medical costs,To the new agriculture joint compensation should be personal burden compliance medical treatment charge gives security.the,High medical costs more than a year the per capita net income of rural residents as decision criteria.In 2013,,First in our province will seriously harm the health and influence farmers' production and life,And definite effect/Easy to control the cost of the 20 kind of major disease into a serious illness insurance coverage,including:Childhood leukemia/Congenital heart disease in children/End-stage renal disease/Breast cancer/Cervical cancer/Heavy sexual mental illness/AIDS opportunistic infection/Resistance to many medicine tuberculosis/hemophilia/Chronic myeloid leukemia/Cleft lip and palate/Lung cancer/Esophagus cancer/Gastric cancer/Type I diabetes/hyperthyroidism/Acute myocardial infarction/Cerebral infarction/Colon cancer/Colorectal cancer, etc.

赔偿额度 Compensation amount

支付比例不低于50%最高达20万元 Payment proportion is not less than 50% of the top 200000 yuan

　　意见规定，新农合大病保险的对象为参合居民。新生儿出生当年，随父母自动获取参合资格并享受新农合待遇，同时享受大病保险待遇，自第二年起按规定缴纳参合费用。

Opinion provisions,New farmers close a serious illness insurance object for ginseng adds up to residents.The baby is born,With the parents to be automatic acquisition ginseng adds up to qualification and enjoy the new agriculture joint treatment,At the same time enjoy a serious illness insurance treatment,In the second year, the press formulary pay ginseng adds up to cost.

　　对于补偿比例问题，意见要求，要按照医疗费用高低分段制定支付比例，原则上医疗费用越高支付比例越高，实际支付比例不得低于50%。同时，随着大病保险筹资、管理和保障水平的不断提高，逐步提高大病保险补偿比例，最大限度地降低个人医疗费用负担。

For compensation proportion issues,Opinion request,According to the medical treatment charge high and low section make payment proportion,In principle, the higher proportion of medical expenses paid higher,The actual payment ratio shall not be less than 50%.At the same time,With a serious illness insurance financing/Management and the unceasing improvement of the level of security,Gradually improve serious illness insurance compensation ratio,Maximize reduce personal medical expense burden.

　　2013年1月1日起，大病保险资金对20类重大疾病参合患者住院发生的高额合规医疗费用给予补偿，个人最高年补偿限额为20万元。此外，在新农合报销、大病保险补偿的基础上，民政部门还将对贫困患者给予一定救助。

January 1, 2013,A serious illness insurance funds to 20 kind of major disease ginseng adds up to in-hospital happen high compliance medical treatment charge gives compensation,Personal highest annual compensation limit for 200000 yuan.In addition,In the new agriculture close to submit an expense account/On the basis of a serious illness insurance compensation,Departments of civil affairs to poor patients will be certain to give assistance.

资金来源 Capital source

从新农合结余中支出资金 New farmers close balance of spending money

　　意见规定，资金原则上从新农合基金结余或年度新增政府补助中支出。2013年，我省购买大病保险的筹资标准为每人15元。每年年初，资金将由统筹地区新农合经办机构从新农合基金支出户中直接列支一定比例或额度作为新农合大病保险资金，用于购买商业保险机构大病保险。

Opinion provisions,The new agriculture capital in principle close fund balance or annual new government subsidies of expenditure.In 2013,,Our province to buy a serious illness insurance financing standard is 15 yuan per person.At the beginning of every year,Funds will be by as a whole area new farming orgnaization of agency of close new farming close fund household spending in a certain proportion of direct recovery or line as the new agriculture close a serious illness insurance funds,Used to buy commercial insurance institutions serious illness insurance.

　　为保障承办商业保险机构的能力，意见要求，以政府购买商业医疗保险形式，通过公开招标确定商业保险机构承办新农合大病保险业务。

To protect the commercial insurance institutions ability,Opinion request,The government purchase commercial medical insurance form,Through the open tender determine commercial insurance institutions undertaking new farming together a serious illness insurance business.

　　卫生行政部门要将招标情况、与商业保险机构签订协议的情况、购买商业保险的筹资标准、保障水平、补偿结算流程及大病保险资金的年度收支情况等向社会公开，接受社会监督。同时，商业保险机构要定期在定点医疗机构、统筹地区分支机构公示大病保险资金收入情况、参合居民医疗费用补偿情况。

The public health administrative department shall tender situation/And commercial insurance agency agreement situation/Buy the commercial insurance financing standard/Security level/Compensation and settlement process and serious illness insurance funds, such as the annual balance to the public,Accept social supervision.At the same time,Commercial insurance institutions should regularly in the fixed-point medical institutions/As a whole the area branch public serious illness insurance capital income/Ginseng adds up to residents medical treatment charge compensation case.

现状 乡镇医院报销多，大医院治病报销少 Present situation of villages and towns hospital more than submit an expense account,Big hospital cure less to submit an expense account

　　“现在看个小病确实花不了多少钱，报销很多，可到大医院看大病就花得多、报得少了。”去年，因急性心梗住进省城大医院的王金生花了近6万元，可新农合仅报销了2万元左右，自己要负担4万元。与王金生有同感的参合患者不在少数。为鼓励农民在基层就诊，新农合的报销比例随着医院等级的升高会降低，当时新农合大病保障报销70%以上的政策还没推广。

"Now see a slight illness really how much money to spend,Submit an expense account many,But to the hospital to see a serious illness to spend more/Reported less."Last year,For acute myocardial infarction live in provincial capital big hospital WangJinSheng spent nearly $60000,But the new agriculture close to submit an expense account only 20000 yuan,You want to burden is 40000 yuan.And WangJinSheng feeling ginseng adds up to patients is not a few.To encourage farmers to see a doctor at the grassroots level,New farmers, reimbursement ratio increased with the rank of the hospital will be reduced,The new agriculture close a serious illness security submit an expense account more than 70% of the policy haven't promotion.

　　“有些药品等不在报销目录里，总体报销比例还要低。”省城一名三甲医院医保办工作人员表示，一般总体报销比例在30%左右。“但大病都要去大医院看啊！”王金生说出了不少农民的心声。(记者 李钢)

"Some drugs and so on not to submit an expense account in the directory,Overall expense ratio is still lower."Provincial capital a 3 armour hospital medical insurance do staff said,General overall expense ratio at around 30%."But serious illness will go to large hospital look!"WangJinSheng say a lot of farmers' heart.(Reporter LiGang)