From next year, Harbin outpatient costs are included in the scope of payment of employee medical insurance overall funds

The Harbin Municipal Government recently issued the "Implementation Plan for the Establishment and improvement of the basic medical insurance clinic for employees". According to the "Implementation Plan", Harbin City incorporates outpatient costs into the scope of payment of employee medical insurance overall funds, simultaneously reforms the personal account of employee medical insurance, improves the efficiency of medical insurance funds, gradually reduces the burden of medical expenses of insured personnel, and achieves a fair and sustainable system. The "Implementation Plan" will be implemented from January 1, 2023, with a validity period of 5 years.

In accordance with the requirements of the provincial "reform of employees' medical insurance account, establish and improve the guarantee mechanism for outpatient help guarantee", the insured person who has established 9.5%of the personal account and the 6.5%of the retirees who have paid 6.5%can directly enjoy the outpatient treatment. Other personnel can change the payment in accordance with regulations. After the proportion to 9.5%, enjoy the guarantee of outpatient help.

Insurance employees within the scope of common outpatient policies occurred by the designated medical institutions, and the maximum payment limit of the upper payment line or above is paid by the overall funding fund in proportion.

Scientific setting annual starting standards, 70 % of the primary medical institutions at the first and below of the staff, 60 % of the secondary medical institutions, and 50 % of the third -level medical institutions. The maximum payment limit is not less than 3,000 yuan, and it is included in the maximum payment limit of the year's basic medical insurance.

The record personnel who have been living in different places and temporarily outing for a long time shall be settled directly in accordance with the provisions of the medical institutions in a designated medical institution in accordance with the regulations of different places.

The drug guarantee services provided by qualified fixed -point retail pharmacies are included in the scope of outpatient guarantee, supporting external prescriptions to settle and distribution at fixed -point retail pharmacies, pay at a certain proportion, and give full play to the convenience and role of fixed retail pharmacies.

After adjustment of the structure of the overall fund and personal account, the increased coordinated funds are mainly used for outpatient protection guarantees and improved the treatment of insured personnel. The principle of personal accounts of the employee is included in the 2 % of the payment base for their insurance insurance. All the basic medical insurance premium paid by the employer is included in the overall funding fund; About 2%of the average level of basic pensions in the year.

Personal account funds are mainly used to pay for insured personnel within the policy scope of the designated pharmaceutical institutions, and can also be used to pay a large amount of medical subsidy fees. It can be used to pay the medical expenses borne by personal burden of personal burden, and the medical expenses that occur in the designated medical institution, and the cost of purchasing drugs, medical devices, and medical consumables in designated retail pharmacies. At the same time, you can pay the personal payment of spouses, parents, and children to participate in the basic medical insurance for urban and rural residents. Personal accounts shall not be used for public health costs, sports fitness or health care consumption, which are not expenditures that do not belong to the scope of basic medical insurance protection.

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.

For grass -roots medical services, you can pay according to the head of the person, and actively explore the combination of paying according to the head of the person and chronic diseases; for daytime surgery and eligible outpatient special diseases, the implementation of groups in accordance with the diagnosis of diseases or diseases; Outpatient costs can be paid according to the project.

Source: Heilongjiang Daily

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