New rules for Harbin employee medical insurance come!Starting next year, the outpatient expenses are included in the scope of payment of the overall fund

In order to further improve the basic medical insurance system of employees who help mutual assistance and responsibility, and better solve the problem of outpatient guarantee for employees' medical insurance insured personnel, the Harbin Government Office issued the "Harbin City Establishing and Improvement of the Greater Insurance Protection Mechanism of the Personal Insurance Clinic for Practitioners in Harbin City "Implementation plan, adhere to the basic guarantee, overall planning, and integrate the outpatient costs into the scope of payment of employee medical insurance overall funds, simultaneously reform the personal account of employee medical insurance, improve the efficiency of medical insurance funds, and gradually reduce the burden of medical expenses for participants. The implementation plan was implemented on January 1, 2023, with a validity period of 5 years.

The coverage scope is in accordance with the provincial "reform of employees' medical insurance accounts, establishing and improving the guarantee mechanism for outpatient help mechanisms", and 9.5%of insured persons who have established personal accounts and retirees who have paid 6.5%of the payment directly enjoy the outpatient treatment. After changing the payment ratio to 9.5%, enjoy the outpatient protection guarantee.

Guarantee Standard

The first is to set the annual starting standards scientifically; the second is that the reimbursement ratio of in -service personnel is 70%, 60%of the second level, and 50%of the three levels, and 50%of the third level. No less than 3,000 yuan.

Reform personal accounts into standards

First, the personal payment of the individual employees is still included in my personal account. The basic medical insurance premium paid by the employer will no longer be included in proportion, and all of them are included in the overall fund; The standard is about 2%of the average level of basic pensions in 2022 that year.

Broadening and standardizing the scope of personal account use

First, personal account funds can be used to pay the insured person and their family members (spouses, parents, children) in a designated pharmaceutical institution. The second is the personal payment for family members to participate in medical insurance for urban and rural residents. Third, it can be used to participate in the insurance subsidy fee. The fourth is to regulate personal accounts and shall not be used for public health, sports fitness or health care consumption.

Strengthen personal account supervision and management

Establish a dynamic management mechanism for the full process of personal accounts, and strengthen the review of personal account use and settlement. Strengthen the supervision of medical behavior and medical expenses, and seriously investigate and deal with illegal acts such as "hanging bed" hospitalization and inducing hospitalization. Establish a safety prevention and control mechanism for medical insurance funds, severely crack down on fraudulent insurance, and ensure the safe and efficient and reasonable use of the fund.

Payment mechanism is improved to adapt to the protection of outpatients

For the first -level medical services, you can pay the first -level medical services, and actively explore the combination of paying according to the head of the person and chronic diseases; for day surgery and eligible outpatient special diseases, implement the diseased or diagnosed group of disease diagnosis; The outpatient cost can be paid according to the project.

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Last News · Life Daily Reporter: Zhang Li

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