国务院新闻办公室于8月1日举行国务院政策例行吹风会，介绍了《关于健全基本医疗保险参保长效机制的指导意见》（以下简称《指导意见》）的相关情况。国家医疗保障局副局长黄华波、财政部社会保障司负责人郭阳、国家卫生健康委医政司负责人李大川、国家税务总局社会保险费司司长郑文敏和国家医疗保障局待遇保障司司长樊卫东出席了会议并回答了记者的提问。
樊卫东在会上表示，《指导意见》提出了一系列激励措施，旨在鼓励居民医保参保人员加强自我健康管理、连续参保缴费。具体措施包括对连续参保缴费人员设置连续参保激励和基金零报销激励，以及对断缴人员再参保设置待遇等待期。
自2025年起，连续参加居民医保满4年的参保人，每连续参保一年，可享受连续参保激励，大病保险最高支付限额每年提高不低于1000元，具体标准由各省制定。中断参保后，前期连续参保积累的年限自动清零，再参加居民医保时，年限需要重新计算，但前期积累的奖励额度继续保留。
对于基金零报销人员，如果当年没有使用过包括门诊、住院在内的所有医疗费用的医保基金报销，下一年度可适当提高城乡居民大病保险的最高支付限额，同样每年提高不低于1000元，具体标准由各省制定。如果当年发生了大病保险报销，前期积累的奖励额度就会被清零，下一年度重新开始计算零报销奖励额度。
樊卫东强调，连续参保激励和基金零报销激励累计提高额度最高可以达到所在统筹地区大病保险最高支付限额的20%。这一激励措施旨在增加参保人因大病导致的经济负担保障，对于连续参保、基金零报销的参保人来说，其大病保险最高支付限额将逐年增加，直至达到最高支付限额的20%。
会议还强调，不鼓励选择性参保，因为这不仅影响个人权益，也对医保基金的平稳运行和整体利益造成不利影响。《指导意见》的实施旨在建立更加长效的参保机制，确保所有参保人的权益得到充分保障，同时促进医保基金的可持续健康发展。
英语如下：
News Title: “New Health Insurance Rule: Enjoy High Rewards for Continuous Participation”
Keywords: Health Insurance Incentives, Continuous Participation, Fund Zero Deductible
News Content:
The State Council Information Office held a regular policy briefing on August 1st to introduce the situation of the “Guidance Opinions on Establishing a Sustainable Mechanism for the Participation in Basic Medical Insurance” (referred to as the “Guidance Opinions”). The meeting was attended by Xu Huabo, Deputy Minister of the State Medical Insurance Administration, Guo Yang, the responsible official from the Ministry of Finance’s Social Security Department, Li Dachuan, the responsible official from the National Health Commission’s Medical Administration Department, Zheng Wenmin, the director of the Social Security Tax Bureau’s Social Security Fees Department, and Fan Weidong, the director of the State Medical Insurance Administration’s Treatment Security Department, who answered questions from journalists.
Fan Weidong stated at the meeting that the “Guidance Opinions” propose a series of incentive measures aimed at encouraging residents to strengthen self-health management and continuous participation in medical insurance. Specific measures include setting up incentives for continuous participation and fund zero deductible for continuous participants, as well as setting a waiting period for treatment benefits for those who have discontinued their participation and then re-participate in medical insurance.
Effective from 2025, participants in resident medical insurance who have continuously participated for four years can enjoy continuous participation incentives, with the maximum payment limit for major illness insurance increasing by no less than 1,000 yuan per year for each consecutive year of participation, with specific standards determined by each province. For those who have discontinued their participation, the accumulated years of continuous participation will automatically reset to zero upon resuming participation, and the years will need to be recalculated, but the accumulated reward amount will continue to be retained.
For those with zero fund deductions, if they have not used any of the medical insurance fund reimbursement for all types of medical expenses, including outpatient and inpatient services, in the current year, they can enjoy an increase in the maximum payment limit for rural and urban residents’ major illness insurance in the following year, with an increase of no less than 1,000 yuan per year, with specific standards determined by each province. If major illness insurance reimbursement occurs in the current year, the accumulated reward amount will be reset to zero, and the calculation of the zero deductible reward amount will start anew in the following year.
Fan Weidong stressed that the cumulative increase in the incentives for continuous participation and fund zero deductible can reach up to 20% of the maximum payment limit for major illness insurance in the corresponding pooling region. This incentive measure aims to increase the economic burden insurance for participants who suffer from major illnesses, and for those who continuously participate and have zero fund deductions, their maximum payment limit for major illness insurance will increase year by year until it reaches 20% of the maximum payment limit.
The meeting also stressed that selective participation is not encouraged, as it not only affects personal rights but also has a negative impact on the stable operation of the medical insurance fund and overall interests. The implementation of the “Guidance Opinions” is aimed at establishing a more sustainable participation mechanism to ensure that the rights and interests of all participants are fully guaranteed and to promote the sustainable and healthy development of the medical insurance fund.
【来源】http://www.chinanews.com/life/2024/08-01/10261675.shtml
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