保障病有所医 四川基本医保参保率稳定在95%以上 中新网成都10月16日电 (记者 王鹏)四川省政府新闻办16日下午在成都召开《关于健全基本医疗保险参 保长效机制的实施意见》政策吹风会。四川省医保局副局长彭波介绍，近年来四川省基本医保参保率稳 定在95%以上。 图为政策吹风会现场。四川省政府新闻办 供图 彭波介绍，2025年9月，四川省政府办公厅印发了《关于健全基本医疗保险参保长效机制的实施意见》 (下称《意见》)。其中，为积极适应人口流动性，《意见》取消在就业地参保的户籍限制，学生儿童可 在常住地或就读地参保，大学生可按学制参保趸缴医保费。 此外，《意见》还扩大了职工医保个人账户共济范围，对象上由家庭成员扩展到近亲属，费用上从支付 居民医保费扩展到支付在定点医药机构产生的自付医药费用；《意见》还对连续参加居民医保人员提高 大病保险最高支付限额，确定连续参保激励额度为每次4000元，激励总额最多可达到大病保险原封顶线 的20%。 在奖励方面，《意见》建立了居民医保基金零报销人员的奖励机制，对当年基金零报销人员，次年提高 大病保险最高支付限额，提高额度为每次4000元。连续参保激励额度和基金零报销奖励额度可以叠 ...

Group 1 - The annual cap for serious illness insurance for urban and rural residents in Sichuan Province is set uniformly at 300,000 yuan [1][2] - Starting from 2025, for residents who have participated in the medical insurance for four consecutive years, the maximum payment limit for serious illness insurance will increase by 4,000 yuan for each additional year of continuous participation [1][2] - For residents whose medical insurance fund reimbursement is zero in the current year, the maximum payment limit for serious illness insurance will also increase by 4,000 yuan in the following year [1][2] Group 2 - The incentives for continuous participation and zero reimbursement can be combined, with a total increase not exceeding 20% of the original cap for serious illness insurance [1][2] - For individuals who have interrupted their insurance, the maximum payment limit for serious illness insurance will be reduced by 4,000 yuan for each year of interruption, with a cumulative reduction not exceeding 20% of the original cap [2] - Individuals who re-enroll after a break will have their continuous participation years recalculated, but previously accumulated rewards for continuous participation will be retained [2] Group 3 - A waiting period for benefits will be established for individuals who have interrupted their insurance, with a fixed waiting period of three months for those who do not enroll during the concentrated enrollment period [3] - For each additional year of interruption, the variable waiting period will increase by one month, which can be reduced by paying additional premiums [3] - The total waiting period for those who have interrupted their insurance for four years or more will not be less than six months after restoration [3]

Core Viewpoint - The article outlines the implementation plan for establishing a long-term mechanism for basic medical insurance enrollment in Chongqing, aiming to address demographic changes and enhance the insurance system's foundation [2]. Group 1: Policy Measures for Enrollment and Benefits - The plan includes relaxing household registration restrictions to encourage participation from various groups, including flexible workers and students, with specific age limits for participation [3]. - It proposes optimizing funding policies, allowing personal accounts to cover relatives' insurance payments and adjusting payment methods for flexible employment [3]. - Improvements in maternity benefits are outlined, ensuring coverage for various scenarios related to childbirth and maternity care [4]. Group 2: Incentive and Constraint Mechanisms - A mechanism to incentivize continuous enrollment and address zero reimbursement cases is established, increasing the maximum payout for serious illness insurance for long-term participants [5]. - A constraint mechanism is introduced for those with interrupted enrollment, imposing waiting periods for benefits based on the duration of non-participation [6]. Group 3: Digital Empowerment and Service Optimization - The plan emphasizes the use of digital tools to enhance enrollment management and service delivery, including a comprehensive database for tracking participants [7]. - It aims to improve service capabilities and user experience through streamlined processes and the implementation of electronic systems for claims and reimbursements [8]. Group 4: Collaborative Efforts - Clear responsibilities are assigned to various departments to ensure effective coordination in enrollment and fund management [9]. - The plan encourages inter-departmental collaboration to support the enrollment of specific groups, such as newborns and unemployed individuals [10]. Group 5: Organizational Support and Funding - The article stresses the importance of strong organizational leadership and collaboration among departments to facilitate the implementation of the enrollment mechanism [12]. - Financial support mechanisms are outlined to incentivize local governments in promoting enrollment and ensuring adequate funding for related activities [14].