From next year, Jiujiang employee medical insurance can be reimbursed for ordinary outpatient clinics

Jiujiang News Network (Xu Chen Jiujiang Daily All -Media reporter Zhou Huichao) Recently, according to the spirit of the national and province on establishing and improving the basic medical insurance outpatient protection system for employees, Jiujiang City issued the "Establishment and improvement of basic medical insurance for employees of Jiujiang City City Implementation Opinions of the Outpatient Affairs Protection Mechanism (hereinafter referred to as "Implementation Opinions"). By establishing a basic medical insurance system for employees in mutual assistance and responsibility, adjust the structure of the basic medical insurance fund of employees, solve the problem of outpatient guarantee of insured personnel, and increase the reimbursement of the basic medical insurance clinics of employees.

The "Implementation Opinions" stipulates that starting from January 1, 2023, within a natural year, the cost of the general outpatient policy of employees exceeds 600 yuan, and the reimbursement is included in the reimbursement according to the corresponding level of designated medical institutions. The reimbursement ratio is first level. 60 %, 55 %, and 50 % of the third level, the maximum payment limit of the year is 1,800 yuan. Participants who enjoy the retirement benefits of employees' basic medical insurance have increased by 5 %, and the maximum payment limit of the year is increased to 2,000 yuan. The "Implementation Opinions" applies to all employees and retirees participating in the medical insurance of Jiujiang City.

At the same time, the "Implementation Opinions" stipulates that reducing personal accounts into standards. From January 1, 2023, personal accounts are included in the following methods: (1) The basic medical insurance premiums paid by the employee by personal accounts Instant, the standard is 2 % of the payment base for participating in the insurance, and all the basic medical insurance premiums paid by the unit are included in the overall fund; I have 2 % of my participation in the payment base; (3) the personal account of retirees is classified by the overall funding fund according to the quota, and the amount is included in the implementation of 2.5 % of the average level of basic pensions in the province that year. After reducing the standards, the portion of the personal account is reduced to the overall fund, which is used for outpatient reimbursement expenses.

So how to settle the expenses of general outpatient medical insurance for employees? Participants should purchase medicines with electronic medical insurance vouchers (or medical insurance cards), and directly settle medical expenses in designated pharmaceutical institutions. Part of the fixed -point pharmaceutical institutions settle in accordance with the relevant regulations of the state and provinces, and municipalities. The medical security agency and designated pharmaceutical institutions are settled for a year for a year. After one year of trial, the Municipal Medical Security Bureau, the Municipal Finance Bureau and other departments adjust and improve the settlement method according to the operation of the funds.

It is understood that my country ’s employee medical insurance has been formally established in 1998. What is implemented is a guarantee model combining the combined fund and personal account. However, with the development of socio -economic development, the limitations of personal accounts have gradually become highlighted. The accumulation of personal accounts of healthy people and non -healthy people is very different. It is imperative.

In April 2021, the General Office of the State Council issued the "Guiding Opinions on the Establishment and improvement of the Great Protection Mechanism of Basic Medical Insurance Outpatient Clinics" (Guoqi Fa [2021] No. 14), which sounded the horn of reform. The core of the reform was from the original. Personal accumulation guarantee models of outpatient medical expenses to change to fund great guarantee models.

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