From July 1st, ordinary outpatient clinics can also be reimbursed

In order to further improve the basic medical insurance system (hereinafter referred to as employees' medical insurance) with mutual aid and responsibility, and effectively safeguard the rights and interests of insured personnel, recently, the Municipal Government Office issued the "Jiaozuo City to establish and improve the basic medical insurance clinic guarantee guarantee The Implementation Plan of the Mechanism (hereinafter referred to as the "Plan"), the outpatient cost is included in the scope of payment of the employee's medical insurance overall fund, reforming the personal account of employee medical insurance, improving the efficiency of medical insurance funds, and gradually reducing the medical expenses of participants.

The "Plan" will be fully launched on July 1.

Ordinary outpatient overall planning system

Employee's highest reimbursement of 1800 yuan

The "Plan" requires that on the basis of the medical security of chronic diseases and special diseases (hereinafter collectively referred to as outpatient diseases) of the people such as hypertension and diabetes. The scope of payment of medical insurance overall funds. Ordinary outpatient clinics cover all insured persons in the medical insurance. The starting payment standard is set at a time, 50 yuan each time, and no payment standards are set up at the level of designated medical institutions at the grassroots level. The maximum payment limit of the annual annual payment of the general outpatient clinics of the employees is 1,300 yuan, and the maximum payment limit of the annual payment of retirees is 1,800 yuan. The general outpatient overall payment limit is not included in the annual maximum payment limit of the employee's medical insurance overall fund.

The general outpatient medical expenses within the scope of the policies above the starting standard and the maximum payment limit shall be paid by the employee medical insurance overall fund in accordance with the regulations. The percentage of the institutional medical treatment is 55%. According to the regulations, the payment ratio of medical institutions such as grass -roots medical institutions such as community health service centers, township health centers, etc. are 60%. After the family doctor signed a contract, the payment ratio of ordinary outpatient medical institutions incurred at the primary medical institutions signed by the contract increased by 5 percentage points on the basis of the above basis. In the future, in accordance with the actual situation of the general outpatient system of employees' medical insurance and the revenue and expenditure of the funds of the fund, the payment standards, the highest payment limit of the year, and the proportion of the payment of the funds of the funds of the year.

There is a change in the accounts of the account

Retired personnel are divided into 66 yuan per month

The "Plan" requires that the basic medical insurance premiums paid by the employees are included in personal accounts, and all the basic medical insurance premiums paid by the unit are included in the overall funding fund; 66 yuan. After adjusting the structure of the overall fund and personal account, the increased coordinated funds are mainly used for outpatient guarantee guarantees and improved the treatment of insured personnel. The employee medical insurance personal accounts are adjusted and implemented simultaneously with ordinary outpatient clinics.

How did the retirees get 66 yuan?

According to the staff of the Municipal Medical Insurance Bureau, according to the Yuzheng Office [2022] No. 15, "The personal account of the retirement personnel is included in the monthly quota of the coordinated fund, and the amount of the region of the overall area shall be based on the average level of the basic pension and monthly month of the year based on the implementation of the reform. According to the data provided by the Municipal Human Resources and Social Security Department, in 2021, in 2021, the average monthly pension of retirees in the city is 3256 yuan, 3256 yuan × 2%= 65.12 yuan, and the nearest will be set up to 66 yuan. Therefore, the per month of the personal account of retirees is determined by 66 yuan.

Expand the scope of account usage

Can be used for family members to see a doctor and buy medicine

The "Plan" requires that personal account funds are mainly used to pay for insured personnel within the scope of policy scope of designated pharmaceutical institutions. It can be used to pay for the medical expenses borne by personal burden of personal burden, and the cost of purchasing drugs, medical devices, and medical consumables that occurred by personal burden of medical treatment in a designated medical institution for medical treatment in designated medical institutions. Personal accounts can be used for personal payment for spouses, parents, and children to participate in the basic medical insurance for urban and rural residents, or I participate in personal payment for employees' large medical expenses subsidies.

Personal accounts shall not be used for public health costs, sports fitness or health care consumption, which are not expenditures that do not belong to the scope of basic medical insurance protection. The municipal medical security department will formulate and improve the management measures for personal accounts and strengthen the statistics of income and expenditure information.

Adjust the standard for hospitalization

The highest payment limit of the year increases to 80,000 yuan

The "Plan" stipulates that in order to further promote the formation of a reasonable hierarchical diagnosis and treatment system, guide patients to seek medical treatment reasonably, encourage insured personnel to seek medical treatment in the city's medical institutions, save medical insurance funds, and adjust the standards of hospitalization of employees in our city: the province The standards for hospitalization of medical institutions at the level and provincial level at or above the provincial level have been adjusted from 800 yuan to 2,000 yuan; the standard for hospitalization of the third -level medical institution at the municipal level is adjusted from 800 yuan to 1200 yuan; Adjustment to 800 yuan; the standard for hospitalization of first -level medical institutions was adjusted from 200 yuan to 300 yuan. If a medical insurance is hospitalized twice or more times in the year, the starting standard is implemented at 50%of the above standards.

The maximum annual payment limit of the employee medical insurance overall fund has increased from 60,000 yuan to 80,000 yuan.

In addition, the "Plan" also stipulates the payment mechanism that is compatible with the guarantee of the outpatient clinic.For the first -level medical services, you can pay at the first person, and actively explore the combination of paying and chronic disease management according to the head of the person.DIP) Paids; outpatient expenses that should not be paid and paid, you can pay according to the project.Scientifically and reasonable determination of medical insurance and drug payment standards, and by adjusting the proportion of personal self -payment, guide medical institutions and patients to actively use drugs with accurate efficacy and reasonable price.Strengthen supervision and management, establish and improve the supervision and management mechanism that is adapted to the guarantee of outpatients, guide the rational use of medical resources, ensure the stable operation of the medical insurance fund, and give full play to the guarantee function.Jiaozuo Daily All Media Reporter Yang Ke reports

- END -