At present, our city has fully established the long-term care insurance system for employees, the following for you to introduce the employee long care insurance treatment policy.
First, which personnel can enjoy the treatment of long worker protection insurance?
Employees and retirees who participate in the basic medical insurance of Linyi City employees (hereinafter referred to as "insured employees") are included in the coverage of the long-term care insurance of employees (hereinafter referred to as "long-term care insurance"), and employees who participate in the basic medical insurance should participate in the long-term care insurance at the same time.
Second, the financing standard of long worker insurance?
Long-term care insurance funds are raised annually through the employee basic medical insurance pooling fund, financial subsidies and individual contributions. The funding standard is 100 yuan per person per year, of which, the employee basic medical insurance pooling fund is allocated 55 yuan per person per year, the same level financial subsidy (including welfare fund) 15 yuan per person per year, and 30 yuan is borne by the individual (a one-time transfer from the employee medical insurance personal account by the medical insurance agency, and if no individual account is established, the individual will pay).
Third, what are the forms of nursing insurance?
According to the long-term nursing needs of the insured workers, different forms of nursing insurance are determined respectively. One is specialized medical care. Medical intensive care units are set up in designated medical institutions to provide 24-hour continuous medical care services for insured employees who meet the conditions for admission to medical intensive care. The second is institutional nursing. Designated point nursing institutions provide 24-hour in-hospital care services for insured workers who meet the institutional care admission conditions. Third, home care. Designated health care institutions regularly assign medical personnel to provide long-term care services for insured workers who meet the entry conditions for home care, or purchase long-term care services from close relatives of insured workers.
Iv. What are the payment scope and treatment standards?
The expenses incurred in line with the national basic medical insurance drug list, diagnosis and treatment list and medical service facilities, as well as the medical care service and life care service items of the municipal medical insurance shall be included in the payment scope of the long-term care insurance fund according to the prescribed standards for the disabled persons who receive special medical care, institutional care or home care in designated medical institutions. There is no minimum payment line for the medical care long-term care insurance expenses incurred by the insured employees within the scope of the policy, and the designated medical institutions and the insured employees carry out instant online settlement. The payment ratio of medical special care and institutional care is 90%, and the remaining expenses are borne by the individuals themselves. Home care shall be paid according to the standard of fixed payment.
Five, how to apply for employee protection insurance?
To apply for long-term care insurance benefits, insured employees should bring a copy of their medical records (stamped with the official seal of the hospital), their ID card, and the ID card of the client, apply to the voluntarily selected municipal medical institutions or the insurance service window of the insured place, and fill in the Application Form for Assessment of Long-term Care Disability Level and the Self-Assessment Form for Long-term Care Disability Level. After receiving the application, the medical institutions and service Windows shall conduct a preliminary review of the materials submitted by the applicants and fulfill the obligation of one-time notification.
Six, how long after the application to enjoy the treatment?
The contractor shall organize the medical experts to complete the assessment work within 15 working days after accepting the application. The contractor shall make a public announcement after the conclusion of the disability rating, the publicity period is 5 days, there is no objection to the publicity, and the applicant or his family will be notified of the conclusion of the assessment. If the applicant has objections to the assessment conclusion, it can submit an application for review to the participating local medical insurance agency within 15 working days from the date of receipt of the assessment conclusion, and the medical insurance agency shall organize the review and issue the review conclusion. The review conclusion is the final conclusion and will not be publicized. At the end of the publicity, applicants who are determined to be severely disabled (level I, level II, level III) through evaluation are eligible to enjoy long care insurance treatment, and enjoy long care insurance treatment from the date of registration procedures for building beds.
7. What is the evaluation standard of employee protection insurance?
Insured workers who have lost all or part of certain functions of the person due to old age, illness, disability, etc., who have been in bed for 6 months or are expected to be in bed for more than 6 months, are unable to take care of themselves, and their condition is basically stable. According to the Evaluation Criteria for Long-term Care Disability Grade (Trial), the evaluation grades of long-term care disability grade correspond to severe disability (grade I, grade II, grade III).
8. What are the service items of Jinming Yu Hospital as a designated institution for long care insurance?
Medical specialized care and institutional care are the same, as follows:
1 Vital signs monitoring;
2 Blood glucose monitoring;
3 Oxygen inhalation guidance;
4 Drug management;
5 Assist in drug administration;
6 Change the dressing;
7. Gastric tube insertion;
8 catheterization;
9. Enema;
10 Venous blood collection;
11 Subcutaneous injection;
12 Intramuscular injection;
13 Intravenous therapy;
14. Fistula care;
15 arteriovenous catheterization nursing;
16 Oral care;
17 Care and guidance of gastrointestinal decompression;
18 nasal feeding tube care and guidance;
19 Tracheal intubation nursing;
20 Sputum aspiration nursing;
21 Atomizing inhalation;
22 Wear and guide of home non-invasive ventilator;
23 perineal irrigation;
24 Bladder irrigation;
25 Indwelling catheter care and guidance;
26 General physical cooling;
27 drainage tube care;
28 Stool specimen collection;
29 Nutritional guidance;
30 Assist with referral.
9. What are the advantages of Jinming Yu Hospital as a designated service institution for long care insurance?
Jin Ming Yu Hospital, which was put into use in 2018, is a non-profit second-level comprehensive medical institution integrating medical treatment, prevention, health care, rehabilitation, teaching, health management and maintenance. The hospital has a staff of more than 200 people, and has four major centers: medical treatment, health management, maternity center and nursing center, including internal and external departments, gynecology, geriatrics, Traditional Chinese medicine rehabilitation, anesthesia surgery, clinical laboratory, imaging department, health examination center and nursing center.
The living rooms in the long care insurance area of the hospital are mainly three rooms, equipped with independent toilets, toilets, and central air conditioning in summer and winter to control room temperature and improve the comfort of the elderly. The hospital restaurant scientifically formulates nutritious meals to ensure high quality diet conditions; In the special care area, the hospital is equipped with enough doctors, nurses and nursing staff to effectively ensure the maintenance needs of the special care area's chief health insurance personnel. For those who are assessed as severely disabled, the hospital will formulate a service plan according to their assessment results, and choose life care services according to the service plan. At the end of the month, the selected service items were accounted for, and the cost borne by the family after the state subsidy was greatly reduced, which greatly reduced the burden on the family of the long-term care insurance personnel.
