From next month, Tianjin Medical Insurance's personal account will be able to "family support"!Operation method →

On June 27, the "Implementation Measures on Implementing the Implementation Measures for Implementing the Implementation of the Affairs of the Basic Medical Insurance Clinic" held by the Tianjin Municipal Government News Implement.

In other words, starting from July 1, 2022, Tianjin officially launched a family support function of personal accounts of medical insurance. The insured of the employee's basic medical insurance participants can use their own relatives (spouse, parents, children), can use the balance of medical insurance personal accounts to pay for the above -mentioned family members to seek medical treatment at the designated medical institution, or buy drugs, medical devices, medical devices, medical devices, and medical equipment at designated retail pharmacies. Personal burdens incurred by medical consumables will also explore the functions such as personal payment for residents' medical insurance and long -term care insurance for residents to achieve family favors.

Gao Lianhuan, deputy director of the Tianjin Medical Insurance Bureau, introduced that in 2021, the city's employee medical insurance general outpatient medical medical treatment was 50.77 million, and the amount of medical insurance fund paid was 8.3 billion yuan. In accordance with the principle of step -by -step implementation, starting from January 1 this year, related policies such as the reform of personal accounts and the highest payment limit for diagnosis, dynamic adjustment door (emergency) diagnosis standards have been implemented. From January to May this year, the city's employee medical insurance general outpatient clinic medical card medical card medical treatment was 21.96 million, and the medical insurance fund had paid 4.5 billion yuan. Family support functions of medical insurance personal accounts will be officially implemented from July 1.

Standard national file requirements

Tianjin focus on six aspects of reform

First, the method of reforming personal accounts

Before the reform, the personal payment part (2%ratio) of the in -service staff of Tianjin was all included in the personal account. The unit payment part (10%ratio) was included in the personal account at the age of 45 at the age of 45 and the age of 45 or more at a proportion of 1.2%.

In accordance with the national requirements, all the payment parts of the employee's medical insurance units have entered the management of the overall fund, that is, 0.8%and 1.2%of the employers' payment parts are no longer included in personal accounts, 2%of the personal payment section continues to be included in personal accounts. constant.

It should be noted that the personal account of retirees in our city has currently implemented a quota, which meets the requirements of the national document quota allocation and allocation standards. It is not in the scope of this reform. The method of reforming personal accounts is mainly considered to consider enhancing the airspace function of the overall fund, improving the ability to resist risks, and building a "cockpit stone" of people's livelihood.

Second, increase the maximum payment limit of the door (urgent) diagnosis

The main reason is to continue to enhance the function of employee medical insurance clinics. The focus is on the maximum payment limit of employee medical insurance (urgent) diagnosis (urgent), which has been increased from 7,500 yuan before the reform to 9,000 yuan. Among them, the starting line to 5500 yuan (inclusive) section, the payment ratio is 75%, 65%, 55%, and 5500 yuan to 9,000 yuan (inclusive) in the first, second, and third -level hospitals. The hospital is unified 55%. At the same time, the reimbursement policy for pharmacy is also improved. Insured personnel purchase medicines at designated retail pharmacies, and implement them in accordance with the relevant reimbursement regulations of designated medical institutions that are prescribed for external prescriptions.

Third, dynamic adjustment door (urgent) consultation standard

Standards for employee medical insurance starting standards are determined by 1%of the average annual salary of employees announced in the previous year, and appropriately tilted to retirees. This policy has realized the linkage of employee's medical insurance payment standards to the level of economic and social development. It will further play the role of the "first level" of the payment standard and guide the reasonable outpatient consumption of insured personnel. At the same time, it is also conducive to reducing the occurrence of fraud and fraud.

Fourth, regulate the scope of personal account use

In order to revitalize the personal account and reduce the fund depreciation, with the approval of the Municipal People's Government, in October 2016, 70%of the employees' personal account in our city will be injected into the financial account of the employee's medical insurance card. Insurance, etc. This time, in accordance with the requirements of national documents, the city's "Implementation Measures" focus on two aspects of reform arrangements:

The first is to regulate the use channels. Investment management is no longer implemented for employee medical insurance personal accounts, and all of them have been closed (since January of this year, no longer injection of capital injection from financial accounts, and the part of the financial account can still be available).

The second is to establish a mechanism for favors. Personal accounts can be used for myself and their families (spouses, parents, children) in a designated medical institution for medical treatment or purchasing drugs, medical devices, and medical consumables in designated retail pharmacies. I use the favor with my family.

The relevant person in charge of the Tianjin Medical Insurance Center introduced the specific use of the medical insurance personal account family for good use of the family.

Which insured person has a medical insurance personal account

Not all insured people have personal accounts, and the residents' medical insurance insured persons have no personal account. Whether the employee's medical insurance participants have a personal account depends on the insurance payment model adopted by the unit. At present, there are two types of insured payment models in our city's medical insurance: first, the unified account combined model, the employer pays at a rate of 10%of the payment base and the individual pays at a ratio of 2%. It is a model of major diseases. The employer or individual pays at 8%of the payment base. This is mainly the model adopted by some companies with difficulty in operating difficulties and individuals' insurance payment.

Under the above two models, insured personnel enjoy the same as outpatient (including Mente) and inpatient medical expenses medical insurance reimbursement benefits. The reimbursement quota and proportion are the same. It should be noted that in accordance with relevant regulations, only in the combination of accounts, the employees and retirees of the insured will establish a personal account of medical insurance. According to statistics, as of the end of May, the city's 6.34 million employees' medical insurance insured persons were 4.86 million, accounting for 76.6%; 1.48 million people with no personal account, accounting for 23.4%.

Dialing criteria for medical insurance personal accounts

After the reform, the personal account of employee medical insurance is divided into different allocation standards according to different people. Among them, the employees are 2%of the payment base for their own insurance, that is, the total amount of the basic medical insurance paid by the individual is all included in the personal account of medical insurance.

Those who are less than 70 years old, 40 yuan per month, 480 yuan throughout the year; those who are 70 years old, 50 yuan per month, 600 yuan throughout the year; old workers who participated in the revolutionary work before the founding of the People's Republic of China were 60 yuan per month, 720 yuan throughout the year.

The connotation of a personal account of medical insurance

According to the provisions of our city, before the reform, the personal account of medical insurance is limited to the use of medical treatment and medical treatment, and cannot be used for use among family members. Since July 1, 2022, Tianjin has officially launched a medical insurance personal account for family support function. The insured of the employee's basic medical insurance participants can use their own relatives (spouse, parents, children), can use the balance of medical insurance personal accounts to pay for the above -mentioned family members to seek medical treatment at the designated medical institution, or buy drugs, medical devices, medical devices, medical devices, and medical equipment at designated retail pharmacies. Personal burdens incurred by medical consumables will also explore the functions such as personal payment for residents' medical insurance and long -term care insurance for residents to achieve family favors.

How to open a medical insurance personal account

Participants can go to various district medical insurance points centers to handle on -site, and can also be handled by online self -service. At present, the following methods are mainly supported by online processing:

The first is to pay attention to the WeChat public account of the "Tianjin Medical Security Fund Management Center", and select "Jin Yantong" in the "Economic Executive Channel" column;

The second is to download the "Golden Medical Bao" APP processing;

The third is to log in to Tianjin Medical Insurance Public Service Platform. There are also platform entrances on the WeChat public account of "Tianjin Medical Security Fund Management Center" ("Out of Channel" - "Network Hall"), which is convenient for you to log in to operation.

After July 1st, you can adopt the above method to open the personal account of the medical insurance in a timely manner. There is no time to do the time limit, and no centralized handling is required. In addition, after the release function is opened, you can adjust and change the user at any time through the above channels. If you have a medical insurance personal account or other medical insurance issues, you can call the Tianjin medical insurance service hotline "12393" at any time to consult. We will serve you wholeheartedly.

Fifth, give full play to the effectiveness of the integration of the reform system

Based on the institutional mechanism of the protection of the protection, the strategic purchase role of medical insurance is used to promote the reform of the three aspects accordingly: First, support the construction of a grass -roots medical service system, help optimize the allocation of medical resources, and facilitate the masses to enjoy medical services nearby. The second is to promote the optimization of common diseases and chronic disease diagnosis and treatment services for primary medical institutions, strengthen the management of chronic diseases, and promote health management. The third is to improve the paid mechanism that is adapted to the outpatient protection guarantee, give full play to the leverage of the medical insurance payment mechanism, deepen the "three medical" linkage, and improve the guarantee function as a whole.

Sixth, arrange some special measures

In addition, in order to further improve the people's sense of gain, some special measures have been arranged in the policy. For example, the outpatient clinics are appropriately tilted to retirees, exploring the eligible "Internet+" medical services, incorporate the scope of protection, and further improve the outpatient clinic Protecting paid methods, etc. The characteristics of this reform also include three aspects: three aspects:

First, the treatment is more affordable. Through reform, the maximum payment limit of employee medical insurance (urgent) diagnosis (urgent) diagnosis has been greatly increased by 1,500 yuan to 9,000 yuan, which benefits more than 6.3 million insured persons in our city, effectively alleviating some of the outpatient medical insurance quotas of chronic disease insured persons. At the same time, the outpatient payment standards are appropriately tilted to the retirement group, which further reduces the burden of seeking medical treatment.

The second is to serve more people. Through reforms, family members have achieved personal accounts (insured and their spouses, parents, children). In terms of purchasing drug reimbursement, we support prescription circulation. Insured personnel can buy medicines at the pharmacy, and we can enjoy reimbursement in accordance with the reimbursement policy of the prescription circulation hospital, and further improve the service experience.

The third is that management is more standardized. Through the reform, the personal account is closed, and the use of the use is limited to the insured person to see a doctor, and expands to the medical expenses buried by individuals such as medical devices and consumables. More standardized.

Source: Tianjin Radio

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