From Beijing next year, employee clinic treatment will not be closed on the top line

The Beijing Municipal Medical Insurance Bureau released the news on the 19th. In order to implement the country's requirements for the reform of the forensic mechanism for outpatient clinics, with the consent of the Municipal Government, the Municipal Medical Insurance Bureau issued the "Notice on Adjusting the Regardless of the City Workers' Basic Medical Insurance Policy" (Beijing Medical Insurance "(Beijing Medical Insurance Insurance" Send [2022] No. 28) to further improve the medical insurance system of employees, improve the efficiency of personal account funds, and reduce the burden of medical expenses for employees. The notice clearly states that starting from 2023, employee clinic treatment will not be sealed, and the door (urgent) diagnosis of more than 20,000 yuan will be paid at 60%. Starting from September 1, 2022, personal account funds have implemented bookkeeping management, and insured persons cannot be freely withdrawn and achieved targeted use.

From next year, employee clinic treatment is not available

Gate (urgent) diagnosis of more than 20,000 yuan and 60%payment

At present, the medical insurance participants in this city have occurred in accordance with the cities (emergency) diagnosis fees that comply with the city's basic medical insurance payment. The maximum payment limit is 20,000 yuan, which exceeds 20,000 yuan. From January 1, 2023, the maximum payment limit of employee medical insurance clinics will no longer be set up, and the reimbursement ratio of less than 20,000 yuan will remain unchanged; 60%of the employees of more than 20,000 yuan will be reimbursed. Insurance), do not cover it. It is expected to benefit 170,000 insured persons each year and reduce the burden on the insured by about 1 billion yuan.

Personal accounts will be used for personal accounts from September 1st

Before September 1st, personal account funds can still be freely withdrawn in the future

According to the state's requirements for the management of basic medical insurance funds, personal account funds shall be dedicated to special funds. Starting from September 1, 2022, personal account funds have implemented accounting management. Insured personnel cannot be freely withdrawn and achieved targeted use. It is mainly used to pay the medical expenses incurred by the insured employees in designated medical institutions or designated retail pharmacies. Before September 1st, the personal account funds in the passbook for medical insurance have been traded, and the insured persons can still use them at any time in the future.

Improve the level of major illness protection

In 2022, the employee's serious illness payment line dropped to 30404 yuan

In order to further reduce the burden of medical expenses of patients with major illnesses, since 2022, the standard for employee's major disease protection starting standard has been reduced from 39,525 yuan to 30,404 yuan. After enjoying the basic medical insurance benefits of urban employees, the insured persons have a “second reimbursement” of the medical expenses of the annual outpatient and inpatient personal self -payment of the annual outpatient and hospitalization, which exceeded the part of the payment standard and the medical insurance for the general illness of the urban employee. The starting standards of less than 50,000 yuan (that is, 30404 yuan to 80404 yuan) are reimbursed 60%, and 70%of the 50,000 yuan (ie 80404 yuan) or more are reimbursed. It is expected to benefit 35,000 insured persons each year and reduce the burden of 120 million yuan for the insured persons.

Improvement of personal accounts

All the unit payment parts are included in the overall fund

Since September 1, 2022, all the basic medical insurance premiums paid by the employer are included in the overall fund, and all the basic medical insurance premiums paid by the employees are included in the personal account, and the payment ratio is unchanged; The quota is divided, and the current standard is still implemented. The 70 -year -old (excluding) is below 100 yuan/month, and the age of 70 is set at 110 yuan/month.

From December 1st, personal accounts can be paid by family

Starting from December 1, 2022, spouses, parents, and children who are allowed to participate in the basic medical insurance of the city to use personal account funds for the use of family members, and pay the relevant expenses stipulated in the scope of personal account use that incurred by the people and the objects of a lot of money, and and of. You can use personal accounts to participate in the basic medical insurance and long -term care insurance payment of urban and rural residents in the city and the purchase of the city's supplementary medical insurance (currently referring to Beijing inclusive health insurance).

Source: Beijing Daily Client

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