《关于开展城乡居民大病保险工作的指导意见》明确，只要基本医保报销后自付部分超过当地年人均收入，参保（合）人可再次报销，实际报销比例不低于50%。记者调查发现，目前多地实施方案陆续出台，从已有效果来看，患大病后报销比例明显提高，家庭负担减轻。

[About urban and rural residents to carry out a serious illness insurance work direction]clear,As long as the basic medical insurance reimbursement since after pay more than the local part in per capita income,ginseng(close)People can submit an expense account again,The actual expense proportion is less than 50%.Reporter survey found,At present many comes on stage in succession plan,Has been to see the effect,After a serious illness with reimbursement ratio obviously improved,Family burden.

　　保险公司承办大病保险，提供异地结算服务 Insurance company to undertake a serious illness insurance,Provide different settlement services

　　2012年12月1日，青海省率先落实该指导意见，截至2013年1月14日，累计为552位城乡居民大病患者结报医疗费用，金额达301.46万元。陕西、福建、浙江、广西、安徽、山东、辽宁、吉林等省份已出台方案，其他各省方案也将陆续出台。其中，青海、福建、山东等9个省份在全省推广实行，其余省份先试点后实行。

On December 1, 2012,The implementation of the guiding opinions of qinghai province,By on January 14, 2013,A total of 552 patients with a serious illness for urban and rural residents and medical costs,A value of RMB 3.0146 million.shaanxi/fujian/zhejiang/guangxi/anhui/shandong/liaoning/Jilin provinces has already issued scheme,Other provinces scheme will also comes on stage in succession.the,qinghai/fujian/Shandong nine provinces in the province to promote,The rest of the first put into practice after the pilot provinces.

　　按照意见的要求，城镇居民医保、新农合参保（合）人是保障对象，山东省先在新农合参合人当中实行，购买商业保险服务，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。

According to the requirements of the opinion,Medical insurance for urban residents/New farming $ginseng(close)Man is the guarantee object,Shandong province first in the new agriculture of ginseng add up to a close,Buy commercial insurance service,For twenty kind of major disease ginseng add up to in-hospital happen high compliance medical treatment charge gives compensation,Personal highest annual compensation limit for 200000 yuan.

　　对于承办方式，各地明确由保险公司承办大病保险，并普遍采取公开招标的方式。青海、山东、重庆等省份实行统一招标确定两家以上保险公司，分区域承办。报销时，青海、广西采用“一站式”服务，建立经办信息平台，在办理出院手续时，医疗机构按照基本医保制度规定给予报销后，对符合条件的城乡居民及时给予大病医疗费用报销，不用再跑到商业保险机构报销。

The way to,Clear all by the insurance company to undertake a serious illness insurance,And generally take public bidding way.qinghai/shandong/Chongqing provinces unified tender determine two or more insurance companies,Points area for.When reimbursement,qinghai/The guangxi"one-stop"service,Establish handling information platform,When the go through the discharge formalities,Medical institutions in accordance with the provisions of the basic medical insurance system after reimbursed,To meet the conditions of the urban and rural residents to timely medical treatment of a serious illness expense,Don't run again to commercial insurance agencies to submit an expense account.

　　很多大病往往要去外地大医院诊治，造成异地报销难题。对此，各地提出，发挥保险公司全国网络优势，提供异地结算服务。有些地方对必须转诊到异地的就医给予同等报销待遇。

A lot of serious illness often go abroad to big hospital treatment,Cause different reimbursement problems.this,Put forward all over,Play the national insurance company network advantage,Provide different settlement services.Some parts of referral to medical treatment must be different to give equal treatment to submit an expense account.

　　筹资水平人均20元以上，多数地区不设封顶线 Funding level per capita twenty yuan,Most places don't have a top line

　　总的来看，大多数地区筹资水平在人均20元以上。经过基本医保报销后个人自付费用达到大病报销要求的，其实际报销比例均不低于50%。

overall,Most of the area per capita funding level in twenty yuan.After the basic medical insurance reimbursement individual out-of-pocket cost after a serious illness to submit an expense account requirements,The actual reimbursement ratio shall not be less than 50%.

　　青海筹资水平较高，人均50元，起付线5000元，也就是说，只要基本医保报销后个人自付费用超过5000元，就可以再次报销50%。吉林城镇、农村居民筹资为人均60元、50元，起付线为8000元。有些地区人均筹资标准按照基本医保筹资的5%来确定。也有一些地方起付线略高，这样报销比例会低一点，受益的人群也会少一些。

Qinghai funding level is higher,Fifty yuan per capita,Line up to pay 5000 yuan,that,As long as the basic medical insurance reimbursement from the individual pay cost more than $5000,You can submit an expense account 50% again.Jilin town/Rural residents per capita financing for sixty yuan/Fifty yuan,The pay line is 8000 yuan.In some areas, per capita financing standard according to basic health care financing to determine the 5%.There are also some place the pay line slightly high,Such reimbursement ratio will be lower,Benefit people also will be less.

　　各省区对报销比例有细化的要求，比如青海规定，在基本医保和大病保险报销后，城乡居民大病患者医疗费用的实际报销比达到80%—90%。广西要求各试点市实际支付比例不低于53%。不少地区采用分段报销法，如宁夏对年度自付费用超过起付线6000元的，按照50%—81%的比例报销，费用越多报销比例越高。

The provinces to reimbursement ratio have refining requirements,Such as qinghai provisions,In the basic medical insurance and serious illness insurance after reimbursement,Urban and rural residents in patients with a serious illness medical costs of the actual reimbursement ratio reached 80% - 90%.Guangxi required the pilot city actual payment proportion is less than 53%.Many regions adopt section to submit an expense account method,Such as ningxia to the annual out-of-pocket costs more than the pay line 6000 yuan,According to 50% - 81% of the proportion to submit an expense account,The higher the more cost reimbursement ratio.

　　虽然多数地区设定了报销的起付线，但也有个别地区设定了报销上限，即封顶线，比如山东新农合大病保险规定报销不高于20万元。更多的省份对报销上限没有作出限定，以更好地帮助参保（合）患者减轻大病负担。

Although most areas set up to submit an expense account pay line,But also have individual areas of set limit to submit an expense account,Top line is,Such as shandong new farming together a serious illness insurance provisions to submit an expense account is not higher than 200000 yuan.More provinces to submit an expense account limit made no limit,To better help ginseng protect(close)Reduce the burden of patients with a serious illness.

　　基本医保、大病保障、医疗救助、商险结合提高保障实效 Basic medical insurance/Serious security/Medical assistance/Business risks combined with actual effect to improve security

　　目前，不断完善制度衔接，筑起多层保障体系，成为各地推进大病保险的一大趋势，提高了保障实效。

At present,Constantly improve the system connection,Build multiple security system,Become a serious illness insurance all promote a big trend,To improve the security effectiveness.

　　青海省实施三道保障线：一为常规保障，即按新农合、城镇居民医保住院统筹基金政策进行常规报销；二为大病保障，对超过5000元起付线标准的合规医疗费用按80%的报销比例给予二次报销。三为医疗救助，即通过以上两个渠道报销后，属于民政救助对象的，按医疗救助政策给予报销，使救助对象医疗费用实际报销比例达到90%以上。

Implementation of qinghai province three way security:A conventional security,Namely according to the new agriculture together/Medical insurance for urban residents in hospital as a whole fund policy for regular reimbursement;2 serious security,Of more than 5000 yuan to pay on line standard compliance medical expenses according to 80% of the proportion of secondary to submit an expense account to submit an expense account.Three for medical assistance,That is, through the above two channels after reimbursement,Belong to civil relief object,According to the medical assistance policy to submit an expense account,Make rescue object medical expenses actual reimbursement ratio above 90%.

　　福建规定，对尿毒症、儿童白血病等20类特定病种，按照“基本医保+大病保险+医疗救助”方式，民政救助对象合规医疗费用实际支付比例不低于90%。此外，省红十字会在新农合、城镇医保、商业保险、民政救助等报销补偿后，对存在医疗费用负担过重、经济陷入困境的大病救助对象给予再一次救助。

Fujian stipulates,To uremia/Childhood leukemia and class specific diseases,According to the"The basic medical insurance + serious illness insurance and medical assistance"way,Civil relief object compliance medical expenses actual payment proportion is less than 90%.In addition,Provincial Red Cross society in the new agriculture together/Urban medical insurance/Commercial insurance/Civil relief to submit an expense account after compensation,The existing medical expense burden overweight/The economy into a dilemma of a serious illness to rescue object again salvage.

　　国务院医改咨询专家委员会委员、中华医学会党委书记饶克勤认为，把基本医保、大病保障、医疗救助制度、商业保险有机结合起来，构建多层次的全民医保体系，强化社会互助共济的意识和作用，形成政府、社会、个人和保险机构共同分担疾病风险的机制，将对保障“病有所医”发挥重大作用。

Cure of the state council consultation experts committee/The Chinese medical association secretary of the party committee RaoKeQin think,The basic medical insurance/Serious security/Medical assistance system/Commercial insurance organic combination,Constructing multi-level universal health care system,Strengthening social help each other in all aid consciousness and action,Form the government/social/Personal and insurance agencies share the mechanism of disease risk,Will guarantee"BingYouSuoYi"Plays a major role.

　　从记者了解的情况来看，该项制度仍有待完善，如新农合统筹区域多在县一级，而意见要求为市一级；城镇居民医保、新农合分属不同部门管理，工作推进和协调存在一定困难。此外，为防范资金透支风险，也需要尽快推动公立医院改革，并对商业保险机构进行有效监管。

The reporter understands from the situation,The system remains to be perfect,Such as the new farming together as a whole area in county level,But opinion required for the city level;Medical insurance for urban residents/New farmers joint belong to different department management,Promote and coordinate the work is difficult in some degree.In addition,To prevent capital overdraft risk,Also need to promote the reform of public hospitals as soon as possible,And the commercial insurance mechanism, effective supervision.