Why is the medical insurance payment life unified?How to settle in a different place?Authoritative response of the Provincial Medical Insurance Bureau

"Southern" magazine all media reporter 丨 Xu Junlian

"Why does the cumulative payment period of employee medical insurance be unified for 30 years and 25 years? How is the settlement work for medical treatment in Guangdong? How to prevent medical insurance fraud? On July 19, the reporter learned from the Provincial Medical Insurance Bureau and the Guangdong Min Sheng Hotline. The improvement of medical insurance services and the management of medical insurance settlement in different places. "

The province's medical insurance payment period is gradually unified

In June of this year, the official website of the Provincial Medical Insurance Bureau released the "Interim Measures for the Transfer of the Provincial Transfer of the Provincial Basic Medical Insurance Relations in Guangdong Province", which proposed that by January 1, 2030, the province's cumulative payment period was unified for 30 years and 25 years of female employees. This change has aroused widespread society.

Liu Biru, a member of the Party Group and Deputy Director of the Provincial Medical Insurance Bureau, explained that the period of unified medical insurance payment will be implemented from July 1 this year. Require. The policy is not the first in Guangdong. At present, 15 provinces in all parts of the country are 30 years and 25 years. "Guangdong is not the first or the last."

The unified payment period can effectively eliminate the imbalance between various places. Liu Biru said that due to historical reasons, the payments of the provinces are not uniform. For example, Yangjiang stipulates that life -long payment is required. "Because medical insurance is now collecting payment. For example, I will enjoy the treatment this year this year. If you want to pay the fee after retirement, you must have a fund accumulation, but in order to reduce the burden on the insured, the part of the medical insurance fund's payment balance must be Supporting many people after retirement medical needs. "Liu Biru said that the per capita life expectancy of residents in my country is prolonged. This is mainly to reduce the burden on the insured.

Why set the years to 30 and 25 years? According to Cai Xinyi, the director of the Provincial Medical Insurance Bureau Treatment Security Division, this is a comprehensive consideration of the number of payment, the payment rate, the average life expectancy, the treatment level, etc., and the comprehensive calculation of the payment period of the provinces across the country is the sustainable development and fair medical insurance development and fairness Sexual results.

Cai Xinyi added that the unified payment period is a gradual process. It is not to say that it will be adjusted to 30 and 25 years immediately on July 1 this year. Some places are for life -long payment, and there are 15 years short. "In summary, we set up by 2030 is a relatively moderate stage, and each city transitions year by year according to its own situation."

Each county in Guangdong can handle cross -province medical medical clinics and settlement

Guangdong is a large population province and an insured province. As of the end of June this year, the number of insureds in the province reached 110 million. At the same time, Guangdong is a province with very rich medical resources and is a medical province. "In order to solve the problem of insured people, we have made a lot of exploration." Liu Biru said that in recent years, Guangdong has actively explored the reform of the medical security system, actively promoted the reform of medical insurance payment methods, the reform of the bidding of pharmaceuticals and medical consumables, insisted on the settlement of medical treatment and settlement methods for different places. Convenience optimization.

It is understood that Guangdong accelerates the transformation of the information system and opens up the medical expenses of the medical treatment. Realize the direct settlement of medical expenses in all provinces and inter -provincial and different provinces in the province and provinces, so that medical settlement for different places covers the cities above the county level. As of the end of June 2022, the province had opened 2,821 fixed -point medical institutions directly settled in the medical clinic in different places in the province, and 2,595 medical institutions were hospitalized directly settlement medical institutions in different places in the province. One year in advance, the National Medical Insurance Bureau "each county has opened at least one cross -provincial -connected designated medical institution to achieve the direct settlement of ordinary outpatient expenses across provinces."

At the same time, the insured can conduct a small procedure of "national medical treatment", "Guangdong Medical Insurance", "Guangdong Medical Insurance" and "Guangdong Province" to conduct medical treatment in different places. Instant check of medical institutions. " After successfully handling the procedures for medical treatment in different places, the medical expenses of medical treatment are settled directly, so that the data can run more legs and run less.

Direct settlement of maternity medical expenses in different places

In the past, it was difficult to imagine that the medical expenses of maternity medical treatment were directly settled in different places. But now, Guangdong has achieved direct settlement in the province of maternity expenses to effectively improve the quality of maternity insurance services. Liu Biru introduced that the pregnancy and maternal feeding and maternal fertility in different places can apply for the filing to the place of insurance. After the filing is successful, the maternity insurance institutions that have direct settlement services in different places in the province have been opened in different places to seek medical treatment. Medical expenses such as fertility and fertility can be settled directly in accordance with regulations.

On the other hand, the outpatient disease has been found under the permissions of the specific diseases of the disease, so that the medical insurance people will be implemented. Guangdong unified province's gateway special disease access standards, put the treatment permissions to designated medical institutions, and the amount of medical insurance for a single prescription is expanded from 4 weeks to 12 weeks. , Ensure the long -term medication needs of patients with chronic diseases. "Patients with hypertension and diabetes do not need to run the hospital frequently."

Receive medical insurance fraud SMS can be processed online and offline

Many places in all parts of the country have happened: criminals send text messages to the insured in the name of the medical insurance department. To add personal information. Zhang Yanchun, director of the Provincial Medical Security Business Management Center, reminded that if the insured person clicks the link in the SMS, the criminals will implement the next step of fraud.

So, will the traditional Chinese medicine insurance department suspend the medical insurance card of the insured? Zhang Yanchun said that there is a very clear statement in the "Regulations on the Supervision and Administration of the Medical Insurance Fund" promulgated by the State. If the insured is suspected of fraud, and refuses to cooperate with the medical insurance department for investigation, the medical insurance department may suspend the networking of the medical insurance card 3-12 3-12 3-12 A month. What situation will involve the fraud and futile insurance of the insured? In daily life, relatives and friends borrow medical insurance cards, and Zhang Yanchun reminded that she must not borrow. "If your relatives and friends don't know, borrow your medical insurance card, and enjoy medical insurance treatment in your name, you will be suspected of fraud; if we enjoy medical insurance treatment, and it is repeated, for example, I spent 1,000 yuan. Money was reimbursed twice and was suspected of medical insurance fraud insurance; in the process of enjoying medical insurance treatment, we had a resale drug or received improper social insurance treatment. These would be suspected of fraud insurance. "

What should I do if the majority of insureds receive such text messages? Zhang Yanchun introduced that there are currently two channels for online and offline. The offline channels can bring their own identity proof, such as ID cards or social security cards. The WeChat Mini Program or the National Medical Insurance APP in Guangdong Province can directly query the insurance status on the Internet. If the old man is inconvenient to move and does not go online, you can call the government service hotline 12345 to inquire about consulting status.

Responsible for this article 丨 Lin Ruchuan

- END -