Who can benefit, how to apply, and where to receive care? The National Healthcare Security Administration responds collectively to hot topics regarding long-term care insurance.

Yesterday, the “Opinions on Accelerating the Establishment of a Long-term Care Insurance System” was officially released. How to implement benefit guarantees and whether the application process is convenient have become the focus of public concern. Regarding key issues such as “who can enjoy benefits, what benefits are available, how much can be enjoyed, where to enjoy them, and how to apply,” relevant officials from the National Healthcare Security Administration responded in detail at a press conference held by the State Council Information Office today, providing comprehensive explanations on system design and operational arrangements.

Who can enjoy benefits? Priority guarantees for severely disabled individuals

In terms of beneficiaries, the policy clearly states that any insured person who has undergone disability level assessment and meets the criteria can enjoy corresponding nursing services and obtain reimbursements.

According to the current assessment standards, disabilities are categorized into three levels: mild, moderate, and severe. At the initial stage of the system, the focus of protection is on severely disabled individuals who are in urgent need and have the heaviest family burden, primarily including those who are bedridden for a long time, cannot take care of themselves, and require assistance from others.

At the same time, to ensure fairness and fund security, localities will use a “common standard” in disability level assessments, implementing a nationally unified disability assessment standard. Regardless of which pooling area the insured person is in, the assessment standards will remain consistent to minimize human interference and ensure every penny is spent on those who truly need it.

As the economy develops and the level of protection improves, the national level will also conduct unified research to gradually expand the coverage to include moderately disabled individuals and other groups.

What benefits are available? Focus on services, not direct cash payments

The long-term care insurance fund is primarily used to pay for the costs of basic long-term care services that meet the regulations, and in principle, cash will not be directly distributed to disabled individuals.

Zhang Xifan, head of the Benefit Security Department of the National Healthcare Security Administration, stated that providing services and reimbursing costs is to ensure that the fund is used for the care of disabled individuals, allowing them to truly benefit.

Currently, the country has formulated a unified catalogue of long-term care insurance service items, including daily care services such as assistance with eating and bathing, as well as medical care services such as routine dressing changes.

Eligible insured persons can determine the specific items they enjoy based on their own needs and recommendations from institutions.

How much can be reimbursed? No deductible, with an annual maximum limit

Long-term care insurance does not have a deductible. However, in terms of reimbursement rates, there are differences in some regions based on the payment levels of residents and employees, to reflect the balance of rights and responsibilities. At the same time, to ensure the sustainable operation of the fund, the system sets an annual maximum payment limit, which cannot exceed 50% of the previous year’s per capita disposable income of urban and rural residents in the pooling area.

Where to enjoy benefits? Three options: home, community, or institution

In terms of service locations for long-term care insurance, there are currently three main options that insured persons can choose based on their circumstances: for those who choose home care, personnel from designated institutions will provide services at home; for those who choose community care such as designated day care centers, they can receive non-full-day services nearby; and for those who choose to stay in designated institutions, they will receive full-day services provided by the institution.

Considering that most elderly people prefer to “age in place,” the “Opinions” encourage the use of home care and community care, and provide preferential funding support, allowing the elderly to receive services and guarantees at home or nearby.

How to apply? Applications can be made at windows or online

Regarding the application process, the National Healthcare Security Administration clarified that it will focus on improving convenience.

Disabled individuals or their family members can submit applications through healthcare service windows or online channels, and provide documents such as identification, application forms, hospitalization records, or diagnosis certificates. After the reviewing agency approves, it will organize professional institutions to conduct disability assessments. Once the assessment is approved, the agency will negotiate the service method with the disabled individual and guide relevant institutions to provide corresponding services for insured disabled individuals.

Is the processing unified? Achieving “three unifications”

In response to public concerns about discrepancies in cross-regional processing, the National Healthcare Security Administration stated that long-term care insurance has achieved “three unifications.”

Nationally unified process. The National Healthcare Security Administration has standardized the nationwide long-term care processing procedures, clarifying how to handle important steps from disability assessment to service provision and reimbursement settlement, what materials are needed, processing time limits, and precautions; these must all be unified nationwide.

Nationally unified forms. The National Healthcare Security Administration has regulated the documentation required for the entire processing of services, and all long-term care institutions use the same set of forms, reducing service costs across regions and institutions.

Nationally unified system. The National Healthcare Security Administration has established a nationwide unified long-term care insurance subsystem, achieving unified operational processes and standardized information collection, facilitating cross-regional data flow and the enjoyment of benefits in different locations.

How to be more convenient? Promoting “online applications” and “mobile applications”

In terms of convenient services, the National Healthcare Security Administration is guiding localities to promote “online applications” and “mobile applications” for long-term care services.

For example, in Banan District, Chongqing, by strengthening data sharing, intelligent screening is conducted for insured persons with a high correlation to disabilities, helping them apply for benefits in a timely manner, achieving “policies finding people”; in Shanghai, assessment software has been developed to enable online applications, online task assignments, on-site handling, on-site assessments, and automatic generation of assessment results.

Huang Xinyu, director of the Medical Service Management Department of the National Healthcare Security Administration, stated that the next step will be to further promote the digitalization and intelligence of service processing, providing insured individuals with higher quality and more tangible long-term care insurance services.