May 31, 2010
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Opinions of the General Office of the State Council on Comprehensively Implementing Critical Illness Insurance for Urban and Rural Residents [Effective]
国务院办公厅关于全面实施城乡居民大病保险的意见 [现行有效]
Opinions of the General Office of the State Council on Comprehensively Implementing Critical Illness Insurance for Urban and Rural Residents
(No. 57 [2015] of the General Office of the State Council)
The people's governments of all provinces, autonomous regions, and municipalities directly under the Central Government; all ministries and commissions of the State Council; and all institutions directly under the State Council:
Critical illness insurance for urban and rural residents (hereinafter referred to as critical illness insurance) is an expansion and extension of the basic medical security system and a new systematic arrangement that gives a further guarantee to residents if large amount of medical expenses are incurred from their critical illness. Since its beginning, the pilot program of critical illness insurance has advanced the coordinated reform of medical insurance, medical treatment and medicine, promoted the combination of government leadership and allowing market mechanism to play its role, improved the management and operation efficiency of the basic medical security and effectively eased the problem of poverty caused by illness and return to poverty caused by illness. For purposes of accelerating the advancement of the development of the critical illness insurance system, consolidating the bottom line of the national basic medical security and allowing more people to benefit, with the approval of the State Council, the following opinions are hereby offered:


I. Basic principles and objectives
(1) Basic principles
1. Adhering to people-oriented security for critical illness. A critical illness insurance system shall be established and improved, the level and accessibility of services of critical illness security shall be improved, the health rights and interests of the people shall be protected in particular and the fact that the people become impoverished or return to poverty resulting from illness shall be effectively avoided.
2. Adhering to overall coordination and coordinated policies. The connection between basic medical insurance, critical illness insurance, medical aid, illness emergency aid, commercial health insurance, charitable aid and other systems shall be enhanced to play the role in coordination and mutual complementation, output sufficient security momentum and form joint security force.
3. Adhering to government leadership and professional undertaking. While the functions of the government in policy making, organization and coordination, supervision and management and other aspects are strengthened, the mode of commercial insurance institutions undertaking critical illness insurance shall be adopted and the role of market mechanism and the professional advantage of commercial insurance institutions shall be made use of, to improve the efficiency, services and quality of the critical illness insurance.
4. Adhering to steady and gradual advancement and constant implementation. The level of critical illness insurance security shall adapt to social and economic development, medical consumption level and burden tolerance of society, among others. Social mutual aid shall be strengthened and a mechanism where government, individuals and insurance institutions share critical illness risks shall be created. The adoption of measures suitable to local conditions and regulated operation shall be adhered to, to achieve the steady and sound operation and sustainable development of critical illness insurance.
(2) Major objectives
Prior to the end of 2015, the critical illness insurance shall cover all insured persons of the basic medical insurance for urban residents and new-type rural cooperative medical insurance (hereinafter collectively referred to as basic medical insurance for urban and rural residents) and effectively ease the burden of medical treatment on residents with critical illness. By 2017, a relatively complete critical illness insurance system shall be established to closely connect medical aid and other systems to jointly play the role of security floor, effectively prevent catastrophic family medical expenditure and significantly improve the equality of medical security for urban and rural residents.
II. Improving the fund-raising mechanism for critical illness insurance
(1) Scientifically calculating the fund-raising standards All regions shall scientifically, meticulously and effectively calculate funds based on the social and economic development, high medical costs incurred by critical illness and fund-raising ability and payment level of the basic medical insurance as well as the guarantee level of critical illness insurance and other factors, and reasonably determine the fund-raising standards of critical illness insurance.
(2) Stabilizing fund sources. A certain proportion or amount shall be allocated from the basic medical insurance funds for urban and rural residents as the funds of critical illness insurance. Regions with a surplus of basic medical insurance funds for urban and rural residents shall make use of the surplus to raise funds of critical illness insurance; regions with an insufficient surplus or without a surplus shall make arrangement with the funds raised annually. The mechanism of multiple-channel fund raising for basic medical insurance for urban and rural residents shall be improved to ensure the sustainable development of the system.
(3) Raising overall arrangements and plans. The critical illness insurance shall be subject to city-level (prefecture-level) overall arrangements and plans and provincial-level overall arrangements and plans or uniform policy and uniform organization and implementation in the whole province (autonomous region or municipality directly under the Central Government) shall be encouraged, to improve the ability to resist risks.
III. Improving critical illness insurance guarantee

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