昆明市决定从1月1日起，实施大病补充医保和困难群体医疗救助制度，大病全年最高可救助5.5万元。近日，昆明市政府第48次常务会议审议并原则通过《昆明市城乡居民大病补充医疗保险实施办法》(以下简称《办法》)和《昆明市城乡困难群体重特大疾病医疗救助实施意见》(以下简称《意见》)，决定从2013年1月1日起，正式实施《办法》和《意见》。

Kunming decision from January 1,,The implementation of a serious illness supplementary medical insurance and group medical assistance system,A serious illness for the highest can save 55000 yuan.recently,Kunming government executive meeting for deliberation and principles through 48 times[Kunming urban and rural residents supplementary medical insurance measures for the implementation of a serious illness](Hereinafter referred to as the[Way to])and[Kunming urban and rural disadvantaged groups and great disease medical treatment Suggestions](Hereinafter referred to as the[opinion]),Decision from January 1, 2013,The formal implementation[Way to]and[opinion].

　大病医保不限制病种 Medical insurance does not restrict disease of a serious illness

　　昆明市医保中心副主任赵洁说，大病医保就是城乡居民医保的“再保险”，这就是说，城乡居民医保参加了基本医疗保险，享受住院等费用报销之后，达到一定的数额，还可以再报销一部分的政策。参加昆明市城乡居民基本医疗保险的参保人无须再为大病医保进行缴费，包含在50元每年的城乡居民医保的费用里。

Kunming medical insurance ZhaoJie, deputy director of the center said,A serious illness medical insurance is medical insurance of urban and rural residents"reinsurance",That is to say,Medical insurance of urban and rural residents to participate in the basic medical insurance,Enjoy in hospital after reimbursement,Reach a certain amount,Return can again for part of the policy.In kunming urban and rural residents insurance of primary medical treatment of ginseng protect people needn't pay for medical insurance of a serious illness,Included in the $50 each year, the cost of the medical insurance of urban and rural residents.

　　对于大病补充医保，昆明市医保中心副主任赵洁区分了与之前报销的不同。简单来说，新的大病医保报销制度，是针对参保人大病自付部分的报销，让参保人自己少掏腰包，自付的部分高了，高于一个标准额度就报销一定比例的费用。而以往的报销政策是高于医保基金的部分来报销，区别就是，比如过去看个大病，大病医保不管参保人花了多少钱，只根据医保基金支付超过多少来报销，而现在是根据参保人自付部分，超过就报销。

For serious illness supplementary medical insurance,Kunming medical insurance center, deputy director of the ZhaoJie to distinguish the different with before submit an expense account.In simple terms,New system of medical insurance reimbursement of a serious illness,Is ginseng protect National People's Congress (NPC) disease pays part of the reimbursement,To protect themselves paid less,Pays part of the high,Higher than that of a standard amount for a certain proportion of costs.Reimbursement policy is different from previous ones in which more than part of the medical insurance fund to submit an expense account,The difference is,Such as see a serious illness in the past,A serious illness medical insurance protects a person no matter how much money,Only according to the medical insurance fund pays more than how to submit an expense account,And now is according to ginseng protect people pays part,More than just submit an expense account.

参保人政策范围内自付医疗费累计： Participant within the scope of policy pays medical treatment to expend accumulative total:

　　2万元以上3万元以下(含3万元)部分，统筹基金支付50%；

20000 yuan and RMB 30000 yuan(Including 30000 yuan)Part of the,As a whole fund pays 50%;

　　3万元以上4万元以下(含4万元)部分支付60%；

30000 yuan and RMB 40000 yuan(Including 40000 yuan)Part of the payment of 60%;

　　4万元以上5万元以下(含5万元)部分支付70%；

40000 yuan and RMB 50000 yuan(Including 50000 yuan)Part of the payment of 70%;

　　5万元以上10万元以下(含10万元)部分支付80%。

50000 yuan and RMB 100000 yuan(Including 100000 yuan)Part of the payment of 80%.

　　在确保基金安全和参保人按政策规定享受保险待遇的前提下，按照政府主导、专业运作的原则，通过政府公开招标，由商业保险公司承保城乡居民大病补充医疗保险。并根据昆明市经济社会发展和城乡居民基本医疗保险基金运行情况，适时对城乡居民大病补充医疗保险的筹资标准、筹资方式和待遇水平进行调整。

Protects a person in ensuring the safety of the funds under the premise of according to enjoy treatment of insurance policy,According to the government/The principle of professional operation,Through the government public bidding,By commercial insurance company accept insurance of urban and rural residents, a serious illness supplementary medical insurance.According to kunming economic and social development and urban and rural residents' basic medical insurance fund operation,Timely to raise standard of supplementary medical insurance of urban and rural residents a serious illness/Financing way and the treatment level.

　　昆明市医保中心副主任赵洁表示，大病医保没有对参保人患有哪种疾病有明确要求，一般的病种在基本医疗里面就可以得到保障，但是大病有一定自付金额的限制，这就表示，小病也不可能纳入大病去报销。

Kunming medical insurance ZhaoJie, deputy director of the center said,A serious illness medical insurance to protect people with what kind of disease have no clear requirements,The general disease in primary medical treatment can be guaranteed,But a serious illness have a pays the amount limit,It is said,Ailment can't into a serious illness to submit an expense account.

全年最高可救助5.5万 The highest can save 55000

　　《意见》规定，在资助城乡困难群众参加城镇居民基本医疗保险，以住院医疗救助为主、以门诊医疗救助为辅的基础上，合理确定重特大病病种，提高重特大病的救助力度，建立覆盖昆明市城乡困难群体的重特大病医疗救助制度。

[opinion]Provisions of the,In urban and rural people to participate in the basic medical insurance for urban residents,Give priority to with hospitalization medical treatment/In the basis of outpatient service medical treatment is complementary,Reasonable determination and great disease disease,Improvement of great assistance,Establishment covers kunming urban and rural disadvantaged groups of great disease medical relief system.

　　救助对象为城乡最低生活保障对象、农村五保供养对象，当地政府规定的其他特殊困难群体。重特大疾病救助病种包括：儿童白血病、儿童先心病、癌症、重度精神病、终末期肾病、耐多药肺结核、尿毒症、艾滋病机会性感染。重特大疾病救助只对救助对象在医疗保险定点医疗机构发生的医疗费用给予救助。在规定的病种救助范围内，门诊救助标准全年累计救助金额不超过5000元，住院医疗救助全年累计救助金额不超过50000元。

Relief object to life of lowest of urban and rural security object/Rural "five guarantees" object,Other special difficulties prescribed by the local government.Great relief diseases including disease:Childhood leukemia/Children FCHT/cancer/Severe mental illness/End-stage renal disease/Multidrug resistant tuberculosis/uremia/Opportunistic infection of AIDS.Great disease assistance only for assistance objects happens in the medical establishment that decide a dot of medical treatment insurance of medical treatment charge gives relief.In the provisions of the disease relief range,Standards for the total outpatient salvage operations amount does not exceed 5000 yuan,Hospital medical relief aid of annual accumulative total amount does not exceed 50000 yuan.

　　《意见》明确，救助对象原则上在辖区的定点医疗机构就诊，因病情的原因确需转院治疗的，经当地民政部门审批，可转到由市民政局确定的定点医疗机构进行诊疗。农村救助对象在辖区内产生的诊疗费用沿用原结算方式，到市民政部门确定的定点医疗机构就诊，采取手工报销的模式，城镇救助对象利用目前建立的“一站式”医疗救助系统进行结算。(朱虹)

[opinion]clear,Relief object in principle in the jurisdiction of the medical establishment that decide a dot,Because the cause of the illness that must turn courtyard of treatment,By the local civil affairs department for examination and approval,Can be transferred to the citizen politics determine the diagnosis and treatment of the medical establishment that decide a dot.Rural relief objects within the jurisdiction of diagnosis and treatment costs continue to use the original method of payment,To the municipal civil affairs department of the medical establishment that decide a dot,Adopt manual to submit an expense account model,Urban rescue object using at present""One-stop" work style"Medical treatment system for settlement.(ZhuHong)