Hubei employee medical insurance has changed new changes

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On June 27, the Hubei Provincial Government Office issued the "Implementation Opinions on Establishing and Implementation of the Establishment and Implementation of the Establishment and improvement of the basic medical insurance clinic for outpatient medical insurance clinics" (hereinafter referred to as the "Implementation Opinions"). There are important changes in Hubei employee medical insurance!

The "Implementation Opinions" is divided into three major and fifteen articles. By incorporating the general outpatient costs into the reimbursement of the overall fund reimbursement, the medical insurance fund's guarantee function is enhanced, the burden of reducing the medical expenses of the people, especially the elderly, and the establishment of a sound guarantee mechanism for outpatient help.

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There are mainly the following content:

The "Implementation Opinions" adheres to the four aspects of the four aspects: adhere to the basic guarantee, implement overall planning, and effectively safeguard the rights and interests of insured personnel; adhere to a smooth transition, maintain policy continuity, and ensure smooth connection before and after reform; adhere to collaborative linkages, improve outpatient clinics The guarantee mechanism and improvement of the personal account system are promoted simultaneously, and the gradual conversion; adhere to the fair and moderate, and within the framework of the overall national system design, the province's outpatient protection policies are standardized and dynamically adjusted. The "Implementation Opinions" is divided into three major and fifteen articles. The overall consideration is to promote employees' medical insurance outpatient guarantee model to shift from individual accumulated guarantee models to social mutual aid protection model. By incorporating ordinary outpatient expenses into reimbursement of the overall fund reimbursement , Improve the efficiency of the fund's use, improve the medical services of the outpatient clinic accordingly, and reduce the burden on the medical expenses of the people, especially the elderly outpatient clinics. There are three main policy arrangements:

(1) Establish a guarantee mechanism for outpatient help mechanisms

1. Establish a general outpatient clinic coordination. The general outpatient treatment expenses that were originally paid by personal accounts were included in the reimbursement of the overall fund, and the level of treatment was clarified:

The first is the starting payment standard. In principle, the employee is not higher than the average salary of the employment personnel of the full -caliber urban units in the previous year in the preparation area. The retirees are not higher than the 0.8%of the average salary of the employment of employment in the full -caliber urban unit in the previous year;

The second is the proportion of reimbursement. The employees are not less than 50%, the retirees are not less than 60%, and the gap between the payment ratio of all levels of medical institutions is not less than 10%in principle;

Third, the highest payment limit of the year. In principle, the employee is not lower than the average salary of the employment personnel of the full -caliber urban unit in the previous year in the preparation area. The retirees' average salary of the employment personnel of the full -caliber urban unit in the previous year in the previous year was about 3.5%.

2. Improve the system of slow diseases, gradually expand the scope of diseases paid by the overall fund, and gradually transition from the type of disease to the cost guarantee.

3. Enhance the guarantee capabilities of fixed -point retail pharmacies, strengthen the management of fixed -point pharmacies, and include the drug guarantee services provided by the eligible fixed -point retail pharmacy into the outpatient guarantee scope, support external prescriptions to provide drugs and settlement at fixed -point retail pharmacies, and give full play to the convenience of fixed -point retail pharmacies, the convenience of the stool, and the convenience of the fixed retail pharmacy, and the convenient retail pharmacies, and the convenience of the fixed retail pharmacy, and the convenience of the stool of the fixed retail pharmacy. Available.

(2) Reform the personal account of employee medical insurance

1. Reform the method of incorporating personal accounts, and the employees are included in 2%of their insurance payment bases, and retirees are included in 2.5%of the average level of basic pensions in each city (state) in 2021.

2. Properly expand the scope of use. In addition to paying the payment fee for insured personnel at the fixed -point pharmaceutical institution, on the premise of realizing the information system support, it can also be used to pay the insured persons and their spouses, parents, and children in designated medicines. The institution ’s personal burden on medical purchase of medicines, purchasing medical devices and medical consumables, I and spouses, parents, and children participated in personal payment of urban and rural residents 'medical insurance, employees' large medical expenses subsidies, and long -term care insurance.

3. Improve the management methods of personal accounts, severely crack down on fraudulent insurance, safeguard the security of the fund, and protect the rights and interests of participation.

(3) Give full play to the effectiveness of the reform system

Support the construction of the grassroots medical service system, optimize the allocation of medical resources, and facilitate the masses to enjoy medical services nearby.Promote the diagnosis and treatment services of common diseases and chronic diseases in primary medical care, strengthen the management of chronic diseases, promote health management, and support the implementation of the "healthy China" strategy.Give full play to the leading role of medical insurance payment, promote the three medical linkage, and coordinate the improvement of family doctors' contract services, hospital prescriptions, etc., and improve the guarantee function as a whole.&&

Source: Hubei Provincial People's Government Network

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