What are the six unifications and four unifications of medical insurance management?

First, we must unify the coverage. The medical insurance system for urban and rural residents covers all urban and rural residents except those who should participate in the basic medical insurance for employees.

Second, we must unify the fund-raising policy. Adhere to multi-channel financing, reasonably determine the unified financing standards for urban and rural areas, and gradually transition in areas where there is a big gap between the existing medical insurance for urban residents and the new rural cooperative medical system.

Third, we must unify protective treatment. Gradually unify the scope of protection and payment standards, keep the proportion of hospitalization expenses within the policy range at around 75%, and gradually improve the level of outpatient protection.

Fourth, we must unify the medical insurance catalogue. All provinces (autonomous regions and municipalities) should, on the basis of the existing medical insurance for urban residents and the new rural cooperative medical system, give due consideration to the changes in the needs of the insured and formulate a unified catalogue of medical insurance drugs and medical services.

Fifth, we must unify fixed-point management. Unify the management measures of designated institutions, strengthen the management of designated service agreements, establish and improve the assessment mechanism and dynamic access and exit mechanism.

Sixth, we must unify fund management. Medical insurance for urban and rural residents shall implement a unified national fund financial system, accounting system and fund budget and final accounts management system. New rural cooperative medical system and policy;

1. Payment time: 20654381October 28th to June 28th, 2065438, February 28th, 2065438 to February 6th, 2068.

2. Insured objects: all urban and rural residents in the county who have not participated in medical insurance for urban workers and medical insurance for urban residents.

3. Payment standard: 20 17 years, the individual financing standard is per person per year 150 yuan. Insured persons participating in the new rural cooperative medical system also enjoy the medical insurance benefits for serious illness of the new rural cooperative medical system.

4. Payment place: the village (community) where the household registration is located or the village (community) where the residence is located.

5. Required information: personal ID card or household registration book.

6. Maximum payment limit during the year: 450,000 yuan (the specific implementation plan is subject to the current document).

For the full text of the plan, please refer to Volkswagen's client.

For a long time, the local management system has dominated the medical insurance handling services, and the names of medical insurance handling items, application materials, handling methods, handling procedures, time limit for completion and service standards are not uniform, which brings inconvenience to people's enrollment registration, medical insurance relationship transfer, remote referral and online settlement, and it is even more difficult to achieve "one-net running".

Recently, the General Office of the Provincial Party Committee and the General Office of the Provincial Government issued the "Implementation Plan of Six Unifies Process Reengineering for Medical Insurance Handling Services", clearly proposing to implement the process reengineering for medical insurance handling services in the whole province, comprehensively promoting the "six unifications" in the name, application materials, handling methods, handling processes, time limit for completion and service standards of medical insurance handling services, and comprehensively improving the informationization, standardization and specialization level of medical insurance handling services. According to Zhen Tianmin, director of Shandong Institute of Medical and Health Science and Technology Information, "six unifications" mean that people will enjoy uniform standards and equal quality services when handling medical insurance business in all parts of the province, which not only improves people's satisfaction, but also fully realizes "online handling", "handheld handling" and "unified management through one network", laying a solid foundation for promoting provincial-level medical insurance planning and nationwide online settlement.

According to Zhang Ningbo, director of the Provincial Medical Insurance Bureau, in accordance with the reform requirements, the medical insurance department has comprehensively rebuilt, streamlined, optimized and standardized 34 livelihood services in three major areas 18.

Specifically, the application materials have been streamlined by more than 30%, the processing time has been shortened by more than 50%, and the business processes of high-frequency livelihood issues such as medical insurance relationship transfer and connection, outpatient chronic disease off-site online settlement, off-site medical referral and hospitalization filing and reimbursement have been optimized and re-engineered, the processing processes have been compressed by more than 50%, and the medical insurance handling services of "online" and "handheld" have not been less than 80%. Before the end of August, 2020, except for the manual reimbursement of medical expenses and the withdrawal of funds from personal accounts, all other matters will be "online" for public business and "handheld" for personal business. Among them, speeding up the implementation of medical insurance transfer and connection, medical settlement system in different places, and implementing three high-frequency service business process reengineering are the "highlights" of the reform.

Reengineering the transfer and connection process of medical insurance relationship. By upgrading the provincial medical insurance relationship transfer platform, canceling the issuance of insurance certificates and mailing paper transfer materials to and from the insured places in the province, the time limit for the transfer of medical insurance relationship will be shortened from 45 working days stipulated by the state to 15 working days, realizing seamless connection of medical insurance benefits.

Promote the instant settlement of chronic diseases in outpatient clinics in different places in the province. Further expand the coverage of direct online settlement of hospitalization expenses in different places, realize the full coverage of online settlement of hospitalization expenses in different towns (streets), and immediately settle eligible patients in different places in the national networked medical institutions in our province. On this basis, the procedures are simplified, and the manual reimbursement process of chronic disease clinics in different places is reformed, and the processing time limit is changed from 30 working days to online instant settlement. Online settlement of medical treatment in different places in the province will be implemented for hypertension, diabetes, etc. 14 chronic diseases included in medical insurance payment, so as to realize immediate reimbursement of medical expenses.

Simplify the referral and referral filing and reimbursement process. For the insured persons who need to be transferred to different places for medical treatment and hospitalization due to disease treatment, they will be directly transferred from the local hospital to go through the formalities, and will no longer be approved by the medical insurance department. Insured people can choose their own medical treatment in all networked settlement hospitals transferred to provinces and cities, canceling the requirement of fixed 1 referral hospitals in the past; At the same time, if multiple referrals are needed, they will be effective within one year after handling the referral procedures, further facilitating patients to seek medical reimbursement.