Xingtai long-term care insurance refers to the social insurance system that provides basic life care and medical care services for the insured who is disabled or semi-disabled for a long time due to old age, illness and disability.
2. What is the coverage of long-term care insurance?
Insured persons who participate in the basic medical insurance in Xingtai City shall participate in the long-term care insurance in Xingtai City.
3. What are the financing channels for long-term care insurance?
Xingtai long-term care insurance fund is raised through multiple channels in accordance with the principle of "fixed expenditure based on income, balance of payments and slight balance". Financing channels mainly include: transfer payment from medical insurance pooling fund, individual contributions, welfare lottery public welfare fund, subsidies from government and other relevant departments, and other subsidies. Encourage enterprises, units, charities and other social groups and individuals to donate funds.
4. What is the financing standard of long-term care insurance?
The funding standard for long-term care insurance is temporarily raised in 50 yuan per person per year. With the continuous development of fund operation and economic conditions, according to the actual situation, the fund-raising standards are appropriately adjusted.
At the initial stage of the establishment of long-term care insurance, the funding standard for urban workers at the city level is tentatively set as 50 yuan per person per year, in which: individual contributions per person per year 10 yuan, overall fund per person per year in 35 yuan, financial subsidies per person per year in 2 yuan and welfare lottery subsidies per person per year in 3 yuan.
5. How to pay individual contributions for long-term care insurance?
To participate in the basic medical insurance for urban workers at the city level, the unit shall withhold and remit the medical insurance premium in one lump sum at the beginning of the year, or the unit shall apply for withholding and remitting it from its personal account of medical insurance; Those who participate in the basic medical insurance for urban and rural residents shall pay together with the medical insurance premium.
6. What are the contents of long-term care insurance services?
Including but not limited to the following:
(1) Make rounds regularly, observe the condition, and detect blood pressure, temperature, pulse and breathing. , and according to the doctor's advice for oral administration, injection and other ways of administration;
② Carry out basic nursing, specialized nursing and special nursing according to nursing level, and strictly standardize disinfection and isolation measures;
(3) Disposal and nursing of various pipes such as urinary tube, stomach tube and fistula, guidance and implementation of fistula nursing, sputum suction nursing, pressure sore prevention and nursing, dressing change and bladder irrigation, and general specialized nursing such as oral care, perineal washing, bedside shampoo and bath wipe;
(4) Collecting and sending samples for inspection;
⑤ Guide the use of oxygen inhalers and ventilators;
⑥ Timely handle patients with obvious changes in their condition, and assist in referral when necessary;
⑦ On the basis of nursing evaluation, provide nutrition guidance, psychological consultation, rehabilitation treatment and health education for patients, health education and rehabilitation guidance for patients and their families, and carry out psychological intervention;
Hospice care for terminally ill patients, through nursing and symptomatic treatment, can alleviate the pain and safeguard the dignity of life.
7. Under what circumstances can I declare long-term care insurance?
Those who stay in bed for more than 30 days due to old age, illness, disability and other reasons, are expected to stay in bed for more than 3 months, can not take care of themselves, and their condition is basically stable, so they need long-term life care and medical care, and can apply for long-term care insurance benefits.
8. What are the service forms of long-term care insurance?
Xingtai long-term care insurance has three service forms:
Professional medical care, institutional care and home care.
9, long-term care insurance application materials:
① Application Form for Long-term Care Insurance for Urban Workers in Xingtai City;
② Social security card;
(3) in-patient medical records or related materials in secondary and above hospitals.
10, long-term care insurance declaration and appraisal process:
I or my family members apply online through the contractor, the designated service organization to be selected and the long-term insurance system. The organizer regularly organizes and arranges two experts to conduct on-site assessment of the applicant's disability rating, and makes a disability rating conclusion within 7 working days, which will be publicized by the personnel department for 7 days, and a notice of disability rating conclusion will be issued after publicity.
1 1, long-term care insurance treatment standard and reimbursement ratio?
Long-term care insurance benefits have no deductible, and the following standards should be applied:
Insured employees who meet the requirements of medical care expenses during medical intensive care and institutional care shall be reimbursed 65% according to the corresponding lump sum standard;
If the insured employees seek medical treatment in designated service institutions outside the overall planning area, the reimbursement ratio will be reduced by 10%.
Long-term care insurance costs are subject to "fixed lump sum, no compensation for overspending". According to the medical service form and the medical qualification and service ability of the designated service institutions, the contract standard is determined respectively. Special medical care and institutional nursing are managed according to the contract of bed day. The lump sum quota shall be implemented according to the following conditions:
Lump-sum daily reimbursement amount for service table-level beds
Medical intensive care 1 level
Medical institution 90 yuan/day 58.5 yuan/day.
Medical special care level 2
120 yuan/78 yuan/day for medical institutions over one day.
Institutional care 50 yuan/day 32.5 yuan/day
Insured persons who enjoy home care enjoy services about 6 times a month, each service is not less than 90 minutes, each service is 120 yuan, and the long-term care insurance fund will reimburse them according to 85% of the standard quota.
Other county reimbursement standards can consult local agencies.
12. What is the coverage of long-term care insurance?
Fixed payment fees include medicine fees, medical care service fees, bed fees, equipment use fees, consumables, etc.
13. How to reimburse the long-term care insurance fee?
The expenses incurred by the insured in receiving long-term care insurance services shall be shared by the insured and the long-term care insurance fund. Part of the long-term care insurance fund shall be paid in advance by the designated service agencies, and the handling agencies shall settle with the designated service agencies quarterly; Part of the personal burden is solved by the insured and the designated service institutions. In principle, half-way settlement is handled every three months; If medical services need to be interrupted or terminated, settlement and discharge procedures can be handled at any time.
If the expenses incurred by the insured in receiving the long-term care insurance service cannot be directly settled with the service organization, the insured or his family members shall submit the social security card, hospitalization bill, detailed list of hospitalization expenses, complete set of medical records, diagnosis certificate, Xingtai City's application form for long-term care insurance for urban workers at the same level, bank cards and other originals and copies, and submit them to the contractor for manual reimbursement after examination.
14. under what circumstances does the long-term care insurance fund not pay?
(1) Expenses to be paid by basic medical care, maternity and work injury insurance;
(2) It shall be borne by a third party according to law;
(3) It has been included in the scope of national laws and regulations such as the protection of the disabled, military disability pension, and prevention and treatment of mental illness;
④ Other circumstances.
15. Is the evaluation result valid for life?
The evaluation result is invalid for life. Long-term care insurance benefits are reviewed once a year, and the benefits that pass the annual review are postponed. At the same time, the designated service institutions will formulate medical care plans in time according to the patient's condition, evaluate the effect every three months, and adjust the plans in time according to the effect or the change of the condition. Those who have recovered their self-care ability after assessment will stop enjoying long-term care insurance benefits.
16, what is a long-term care insurance institution?
Institutions refer to organizations responsible for raising, paying and settling long-term care insurance funds, handling services and managing daily agreements.
17. What is a long-term care insurance contractor?
The contractor refers to the long-term care insurance determined by public bidding.
Commercial insurance companies that undertake qualifications and sign service agreements with agencies.
18. What is the designated service organization for long-term care insurance?
Designated service institutions refer to medical, pension or other third-party service institutions that meet the requirements in this overall planning area and sign long-term care insurance service agreements with agencies.
19, designated service organization of long-term care insurance at the municipal level.