From September 1st, the personal account of the medical insurance of Qiannan Prefecture can be used for the use of spouses and children and children

Recently, the Office of the Qiannan Prefecture People's Government issued the "Implementation Plan for the Establishment of the Establishment of Employees' Basic Medical Insurance Outpatient Clinic for the Establishment of Employees", which clarified the medical insurance reimbursement of the outpatient clinic of employees. Starting from the 1st.

The plan points out that in order to further improve the basic medical insurance system of employees who help mutual assistance and responsibility, better solve the problem of outpatient guarantee for employees participating employees, effectively reduce the burden of medical expenses of employees in the insurance, and follow the "General Office of the General Office of the Provincial People's Government on the establishment and improve employees of employees. The implementation opinions of the basic medical insurance outpatient forensics guarantee mechanism "required to formulate the plan.

Citizens are queuing in order to pay

The plan is clear that all the basic medical insurance premiums paid by the unit are included in the overall funding fund, and the flexible employees participating in the employee medical insurance are included in the personal account at 2%of the basic medical insurance premium base. The personal account of retirees is classified by the overall planning fund according to the quota, and the standard is 1200 yuan per person per year. Personal accounts of employee medical insurance can be used to pay for the medical expenses that they should be borne by personal burden on the targeted medical institutions, and they can also be used for the medical insurance premiums of urban and rural residents in the province in the province. Gradually explore personal accounts for spouses, parents, and children to participate in basic medical insurance for urban and rural residents outside the province, as well as inclusive short -term commercial health insurance that is closely connected with basic medical insurance. In a natural year, the annual starting standard of ordinary outpatient clinics is 150 yuan per person per year, and the maximum payment limit for the coordinated fund is 2,000 yuan. In the first- and third -level medical institutions, including community health service centers, township health centers, community health service stations, village clinics, etc., the percentage of funds in the policy scope is 70%, 60%, and 50%. Based on the payment ratio of the level of medical institutions, it is increased by 5%. Relying on the province's prescription flow transfer platform, a designated retail pharmacy that achieves electronic traceability and other conditions for the drugs sold, conducts "dual channels" management of negotiated drugs, and implements unified implementation Reimbursement policy. Implement the province's uniform slow special disease outpatient disease scope, disease name name, standards and treatment policies, and properly liberalize the number of medical institutions for medical institutions for medical institutions for medical institutions for medical institutions for medical institutions in patients with qualified diseases. Medical needs. For chronic diseases with clear daily surgery and eligible outpatient treatment plans and clear evaluation indicators, it is implemented to pay according to human heads and diseases. Related fund payment fees are not included in the highest payment limit of the annual outpatient clinic. If the insured persons are used for medical institutions for the fixed -point medical institution, they will issue a direct settlement of their medical insurance electronic vouchers or social security cards, and valid identity documents. Personal accounts can use the designated pharmaceutical institutions that realize network settlement directly. They do not have the conditions for direct use of the use of the conditions for settlement.

The masses orderly queue in line to handle medical insurance business

The plan emphasizes that the improvement of hierarchical diagnosis and treatment and family doctors' signing services, implement long -term prescription management of common drugs for patients with special diseases, support grass -roots medical institutions to do a good job of daily chronic disease management and common disease diagnosis and treatment, and encourage insured personnel to seek medical treatment at the grassroots level. Establish a unified and standardized general outpatient outpatient clinic for employees in the whole state. The business processes and expense settlement methods have been established, and the management of staff training management and outpatient planning fund management will be strengthened. Adhere to the principle of settlement and balance of payments, strengthen the budget management of medical insurance funds, fund audit systems, and internal control systems, and reasonably determine the level of outpatient protection protection. Strengthen the review of personal accounts, settlement, payment, etc., and realize the full process of personal accounts to ensure the smooth operation of the fund. Improve the safety prevention and control mechanism of the medical insurance fund, incorporate the general outpatient clinics of employees into the management of the agreement of fixed -point medical institutions, strengthen the supervision and assessment of medical institutions, promote the standardized diagnosis and treatment behavior of designated medical institutions, and promote the medical insurance credit management of designated pharmaceutical institutions. Strengthen the intelligent monitoring of the big data of medical insurance for outpatient medical expenses, and severely crack down on illegal and illegal acts such as fraudulent insurance such as over -diagnosis and treatment, unreasonable medication, and personal account cash withdrawal to ensure the safe and efficient and reasonable use of the fund.

Qiannan Prefecture Medical Insurance Department guides pharmacies to promote the use of medical insurance electronics

The plan requires that the medical insurance department is responsible for the commissioning and launch of the medical insurance information system platform. The county (cities) people's governments and relevant departments of the county (city) should properly handle the policy connection before and after the reform, accurately interpret and publicize the establishment of basic medical insurance for employees The significance and role of the outpatient protection mechanism. During the implementation process, in accordance with the operation of relevant national and provincial policies and the operation of the medical insurance fund of Qiannan Prefecture, the personal accounts were adjusted in a timely manner, and the standards of general outpatient clinics were adjusted.

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