Heavy!From July 1st, the medical expenses of the employees of Yantai employees were included in medical insurance reimbursement

Jiaodong Online June 23 (Reporter Wang Xiangrong) Recently, the reporter learned from Yantai Medical Insurance Bureau that the municipal government office has issued documents. From July 1 this year, Yantai City will launch a system of general outpatient medical insurance clinics and incorporate the outpatient costs into into The scope of payment of employee medical insurance overall funds to reduce the burden of medical expenses of the insured's outpatient clinics.

Ordinary outpatient clinics can be reimbursed by ordinary outpatient clinics

Starting from July 1, 2022, the person who participated in the city's employee medical insurance and normal enjoyment (including flexible employment staff) was included in the general outpatient guarantee guarantee of employee medical insurance. Participants occur in the designated medical institutions of general outpatient medical insurance in our city, which meets the medical insurance policy of medical insurance policies (ordinary outpatient expenses that meet the national medical insurance and drug catalogs, the catalog of diagnosis and treatment items, and the service facility catalog that occurred in the insured employees). to reimburse.

During a natural year, the standard payment standard for the first and below designated medical institutions was 500 yuan, and the standard payment standard for the second and third -level designated medical institutions was 800 yuan. If the insured will change the designated medical institution within the year, the accumulated payment standard does not exceed 800 yuan.

The reimbursement ratio of the designated medical institutions in the first -level and below of the first -level and below is 70%, the reimbursement ratio of the second -level designated medical institution is 60%, and the reimbursement ratio of the third -level designated medical institution is 50%. The reimbursement ratio of retirees has increased by 5 percentage points compared to the employee.

During a natural year, the highest reimbursement limit for general outpatient medical expenses of working employees and retirees was 1,800 yuan, and 900 yuan in 2022.

Practice fixed -point management

The general outpatient clinic of employees' medical insurance shall be planned for medical treatment. Participants shall seek medical treatment in the real -name medical institution in the general outpatient medical institution of employees in our city. The general outpatient medical expenses incurred by non -fixed -point medical institutions will not be reimbursed. Participants can pay attention to the WeChat public account "Yantai Medical Security Bureau" or log in to the official website of the Yantai Medical Security Bureau to inquire about the list of designated medical institutions of ordinary outpatient clinics in the city. No need to hold a social security card or ID card.

You need to pay the basic medical insurance premiums of employees in time

The premise of enjoying the overall guarantee of the general outpatient clinic of employees is to participate in the medical insurance of employees in our city and enjoy the treatment normally. Enjoy medical insurance treatment.

Example

One day, the employee Xiao Li went to the general outpatient clinic of the general outpatient medical institution of the employee's medical insurance. It cost a total of 700 yuan, of which 600 yuan complied with the medical insurance policy. Paying standards, reimbursed at the proportion of 70%of the first-level medical institutions. If Xiao Li is still at the first and below medical institutions, the general outpatient medical expenses he paid can be reimbursed at 70%, until the annual reimbursement limit is reached.

After a few days, Xiao Li went to our city's employee medical insurance general outpatient clinic for a designated third -level medical institution for ordinary outpatient clinics. The total cost 1,000 yuan, of which 900 yuan in compliance with the medical insurance policy. 800 yuan, this year Xiao Li's payment standards have accumulated 500 yuan in the first -level medical institutions. Then, after a total of 300 yuan reaches the starting standard of the third -level medical institution, the remaining expenses are 50% according to the third -level medical institution 50%. The proportion of reimbursement, so Xiao Li can reimburse the general outpatient cost (900-300) × 50%= 300 yuan.

In this way, Xiao Li went to other ordinary outpatient medical institutions for general outpatient medical treatment. The costs that occurred in accordance with medical insurance policies could be reimbursed at the level of medical hospitals until the highest reimbursement limit of the year.

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