From September 1st, the most complete strategy for "outpatient help" of Guiyang Gui'an employee medical insurance, please collect

On July 4, the Guiyang Medical Insurance Bureau informed the public to the policy interpretation of the "Implementation Plan for the Establishment and improvement of the basic medical insurance clinic for basic medical insurance clinics" (hereinafter referred to as the implementation plan) to the society.

The "Implementation Plan" stipulates that starting from September 1, the use of personal accounts for personal accounts. Starting on January 1, 2023, Guiyang Gui'an began to implement the "outpatient help" of employees' basic medical insurance. The increased funds that increased the overall funds after adjusting the overall fund and personal account structure were mainly used to establish an outpatient coordination guarantee mechanism. Reduce personal accounts, establish general outpatient guarantees, and adopt a policy linkage conversion promotion system to be more fair, and strive to solve problems such as common personal accounts such as common diseases and multiple diseases.

For this new medical insurance policy, many citizens praise the specific operational links of how the family can help the whole family and how to reimburse outpatient clinics.

The reporter interviewed the relevant person in charge of the Guiyang Medical Insurance Bureau on this issue.

Q: What is "outpatient collection"?

Answer: In layman's terms, "outpatient help" has two meanings. One is to coordinate and help. The most important change of the "outpatient help" implemented now is to give full play to the help of the fund -made fund, reimbursing the general outpatient expenses that are in line with the scope of medical insurance policies in the designated medical institutions, so that patients with outpatient medical treatment can also enjoy Reimbursement for reimbursement of the Fund. The second is the account of the account. After the implementation of the "outpatient collection", the personal account of the insured employees can be used by spouses, children, and parents, and clearly explores the personal account for the basic medical insurance for the spouse, parents, children inside and outside the province. And personal payment of inclusive short -term commercial health insurance, which is closely connected with basic medical insurance, has effectively improved the efficiency of personal account use.

Question: When will the personal account family be launched?

Answer: Starting from September 1, 2022, the employee's medical insurance insured in Guiyang's Gui'an area can be used by personal accounts.

Example: Xiao Zhang worked at a company in Guiyang, and there were more than 3,000 yuan in medical insurance cards. Xiao Zhang's parents were bringing him a child to the medical insurance of urban and rural residents paid in Guiyang. After September 1st, Xiao Zhang's parents wanted to buy medicines at designated pharmacies in medical insurance or see a doctor at the fixed -point medical institution clinic. When they met the prescribed costs, they could pay with Xiao Zhang's personal account.

Question: After the implementation of the "Outpatient Clinic", what are the main improvements of the treatment of employees in insured?

Answer: 1. Outpatient clinics are scratch. Outpatient medical treatment can be reimbursed, and minor illnesses are also guaranteed. The outpatient costs that meet the scope of the medical insurance policy can be reimbursed by a coordinated fund; for example, some common diseases, colds, fever and diarrhea, these diseases can be reimbursed!

2. The scope of personal account payment is expanded. First, the insured can use the relevant expenses within the scope of the scope of the personal account payment policy with their spouses, parents, and children. Explore personal accounts to participate in the medical insurance for urban and rural residents, and purchase inclusive short -term commercial health insurance that is closely linked to basic medical insurance.

Question: Who can enjoy the general outpatient clinic coordination protection treatment? When will this policy start? What are the specific regulations?

Answer: (1) Scope of protection: employee medical insurance insurers (including flexible employment personnel identity insurance) ordinary outpatient medical expenses are included in the scope of payment of the overall fund.

(2) Starting time: From January 1, 2023, employee medical insurance insurers can enjoy this policy treatment.

(3) Specific treatment regulations: The maximum annual payment limit of the general outpatient clinic coordination fund is 2,000 yuan. This is a pure reimbursement amount. Is it very powerful? It is basically enough to see a small illness and pain.

The annual starting standard is only 150 yuan, which can easily cross the payment line and enjoy the reimbursement treatment.

The proportion of payment within the policy scope of medical institutions at all levels is also very, very powerful, 75%of medical institutions first and below, 70%of the secondary medical institutions, and 65%of the third -level medical institutions. For retired veteran comrades, the government also considered that special tilt policies should be given, and the percentage of payment percentage of medical institutions at the same level is 5 percentage points higher than that of employees.

Example 1: Xiao Li works in the XX factory. He usually has a good body, but he also has a cold. He needs to prescribe medicine or dripping at the outpatient clinic of the medical institution to enjoy the reimbursement. The expenses after the starting line will be reimbursed in proportion. For example, he generated a total of 1,000 yuan in policy expenses, reduced the starting line of 150 yuan, and reimbursed at 850 yuan at the reimbursement ratio. If it is a first -level medical institution, the policy stipulates that the reimbursement ratio is 75%, and Xiao Li can reimburse 637.5 yuan, and the starting line this year has reached, and no need to calculate the payment line without calculating the annual consultation.

Example 2: Lao Chen is a retired employee, suffering from the varicose veins of the lower limbs, and usually goes to the hospital clinic for some examinations. Some medicines are prescribed. The personal account is basically no balance and is not enough. With outpatient coordination, he can reimburse 2,000 yuan a year. For example, on January 15th, he went to the community hospital to check the prescription of 600 yuan in compliance medical expenses. According to the outpatient co -ordination policy, the starting payment line was 150 yuan, 450 yuan entered the reimbursement scope, reimbursed at 80%proportion, and you can reimburse it. 360 yuan.

Example 3: Lao Zhou has retired for more than two years. He usually has a high blood pressure. The hospital diagnosed as a primary hypertension I, because the condition is mild, not in line with the conditions of the "Outpatient Slow Special Disease Medical Certificate". Health awareness is high. Usually, you must go to the hospital outpatient clinic for relevant examinations, and open the medical expenses of pressure -lowering drugs. After establishing an outpatient clinic coordination, you can reimburse them in accordance with regulations. Question: Can employees apply for "Outpatient Slow Special Disease Medical Certificate", can I still enjoy the overall treatment of outpatient clinics?

Answer: Yes. The expenses stipulated in the slow special disease policy are reimbursed according to the treatment of slow special diseases, and the reimbursement quota of slow special diseases is enjoyed. The outpatient medical expenses that do not meet the policy specified by the slow special disease policy are included in the general outpatient clinic reimbursement and enjoy the overall reimbursement amount of ordinary outpatient clinics, namely: 2,000 yuan/year.

Example: Xiao He is an employee of the logistics industry, suffering from primary hypertension, and handled the "Outpatient Slow Special Disease Medical Certificate" in accordance with regulations. The designated medical institution chose to at the XX Mining Bureau Hospital (first -level medical institution) and XX The District People's Hospital (secondary medical institution) usually goes to the outpatient clinics of these two hospitals to check the medicine. As long as it is a compliance medical expenses related to the hypertension of the disease of the certificate, they will be reimbursed in accordance with the slow special disease policy. Now with the outpatient clinic coordination, if he goes to the outpatient examination of the Hospital of X Mining Bureau because of acute enteritis, the cost of 800 yuan will be reduced, and the starting payment line will be 150 yuan. Reim on 487.5 yuan.

Question: Why should I improve my personal accounts? When will the new measures start?

Answer: The medical insurance system we now implement is a guarantee model of combining social overall planning and personal accounts. The improvement of demand, the limitations of personal accounts are gradually prominent. The main problem is that the guarantee function is insufficient, the anesthesia is not enough, the effect of reducing the burden of medicine is not obvious, the disease is not enough, and it cannot be used by those who are not sick. The state has made a top -level design on the medical insurance system of the employee to promote personal account reform. It proposes that the increase of the overall funds that increase the overall funds and personal account structures are mainly used to establish a normal outpatient coordination guarantee mechanism and improve the treatment of insured personnel.

From January 1, 2023, the reform of personal accounts will be reformed. After the implementation of the policy, all the personal payment parts (2%of the payment base) of the employees are all included in the personal account. The average level of provincial pensions is set into 3%. Flexible employees have enjoyed the benefits of endowment insurance and have reached the period of medical insurance payment, the personal account is classified by the overall funding fund according to the fixed amount, and the average level of pensions in Guizhou Province is included in the standard. If the period of medical insurance payment is reached, the personal account is classified by the overall planning fund at a fixed amount, and the average pension of pension in Guizhou Province is divided into standards.

(Source: Guiyang Daily Tianyan News)

Edit: Liu Yanhong

Coordinating: Zhang Qiang

Editor: Wei Chenghua

- END -