The National Healthcare Security Administration (NHSA), in conjunction with the Ministry of Finance and State Taxation Administration, has issued a notification with the goal of enhancing the basic medical insurance coverage for urban and rural residents in 2024.
The notification emphasizes the need to continuously increase funding for residents’ medical insurance, adapting to the rising life expectancy and evolving medical consumption levels, and solidifying the benefits of residents’ medical insurance. For 2024, both government subsidies and individual contributions to the insurance have seen an increase of RMB 30 and RMB 20, respectively, compared to the previous year. Each individual is now entitled to a minimum of RMB 670 and RMB 400 per year in government subsidies and personal payments, respectively. This marks the first instance since 2016 where the new personal payment standard is lower than the financial subsidy standard.
The document also calls for a steady improvement in the level of basic medical security, an enhanced major illness insurance precision guarantee capability, and an increase in the protection of residents’ medical and maternity medical expenses. The government is committed to consolidating the level of hospitalization security, maintaining a stable policy payment ratio of around 70%, and promoting the implementation of family mutual assistance policies for employee medical insurance. The document outlines the need to set deductible standards, reimbursement ratios, and maximum payment limits for major illness insurance, with the combined maximum payment limit for residents’ medical insurance and major illness insurance aiming to reach approximately 6 times the per capita disposable income of urban and rural residents from the previous year. The reimbursement ratio is to be skewed towards higher medical expenses.
Prenatal check-up costs will be incorporated into outpatient security, and the level of medical expenses for hospital delivery and childbirth will be reasonably enhanced.
Furthermore, the document mandates that all provinces strictly enforce the incentive mechanism for major illness insurance benefits, offering continuous insurance incentives for residents with consistent medical insurance participation and those with zero reimbursement. Individuals with at least four years of continuous insurance coverage will be eligible for an increased maximum payment limit for major illness insurance as per regulations. The zero reimbursement incentive allows for the next year’s benefits to be enjoyed tax-free, with the maximum payment limit also being increased accordingly. These incentives will be independently established and implemented from 2025.
For those meeting the incentive conditions, the maximum payment limit for major illness insurance will be raised, with each increment set at no less than RMB 1000, significantly exceeding the RMB 400 contributed by individuals.
The document sets a clear timeline for the completion of the 2025 resident medical insurance participation and payment work by the end of February 2025. It also calls for the establishment of a long-term mechanism to prevent and resolve poverty due to illness, ensuring that the participation rate of low-income and impoverished rural populations remains at no less than 99%. The inclusion of eligible village clinics in the medical insurance settlement scope is confirmed to be completed by the end of 2024, with administrative villages housing multiple clinics ensuring that at least one clinic is included in the designated medical insurance management.- Flcube.com
