Guiyang Gui'an employee medical insurance welcomes major changes: personal accounts can be used for family members

On July 4th, the reporter learned from the media ventilation organized by the Guiyang Medical Insurance Bureau that recently, Guiyang City issued the "Implementation Plan for the Establishment and improvement of the basic medical insurance clinic for employees" (hereinafter referred to as the implementation plan), from From September 1st this year, personal accounts will implement family support, and employee medical insurance personal accounts can be used for family members. From January 1, 2023, the general outpatient medical expenses of employees' medical insurance insured (including flexible employment personnel) will be included in the scope of payment of the overall fund, with a maximum reimbursement of 2,000 yuan a year.

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According to the relevant person in charge of the Guiyang Medical Insurance Bureau, the implementation of the "Implementation Plan for the Establishment and improvement of the basic medical insurance clinic for employees' basic medical insurance clinics", mainly to further exert the function of further playing the basic medical insurance for employees. The basic principles of overall planning for aid, stable transition, continuous policy, coordinated linkage, and adapting to local conditions ", reforming employee's personal accounts, establishing and improving employees' outpatient guarantee system for ordinary outpatient clinics and slow special disease clinics, improving the efficiency of medical insurance funds, effectively reducing employees The burden of medical expenses for outpatient medical insurance insured persons.

For the majority of employees, the biggest benefit is that the establishment of a general outpatient clinic coordination guarantee mechanism means that employees can only be paid by personal accounts in the clinic, but are reimbursed by the medical insurance fund according to the prescribed proportion and limit. Although the proportion of personal accounts has decreased after the implementation of the outpatient clinic, the annual outpatient reimbursement amount exceeds the amount of the personal account, and the insured persons have not lost.

The "Implementation Plan" clearly states that starting from January 1, 2023, the general outpatient medical expenses of employee medical insurance insured (including flexible employment personnel) are included in the scope of payment of the overall fund, and the highest payment limit for the annual overall fund of ordinary outpatient clinics is 2,000 yuan Essence For employees for medical insurance medical institutions, the general outpatient clinic overall annual payment standards are determined to be 150 yuan. The proportion of payment within the policy scope of medical institutions at all levels is: 75%of the first and below medical institutions, 70%of the secondary medical institutions, and 65%of the third -level medical institutions. 5 percentage points of employees.

Implement a standardized unified slow special disease outpatient guarantee system to maintain the stable number of diseases and the level of treatment. At present, 37 Guiyang Gui'an Slow Special Diseases, of which the province is implemented in the province. 31, continue to implement 6 original diseases in Guiyang, the names, standards and treatment policies are unified.

According to the "Implementation Plan", starting from September 1 this year, personal accounts will be implemented, and employee medical insurance personal accounts can be used for their families. At present, personal accounts are mainly used to pay for insured personnel within the scope of policy scope of fixed -point medical institutions or fixed -point retail pharmacies. After the implementation of the plan, the personal account of the employee can be used to pay the insured persons and their spouses, parents, and children in the designated medical institution for medical expenses, and the purchase of drugs, medical devices, and medical consumables at designated retail pharmacies at designated retail pharmacies. The cost of the individual.

At the same time, personal accounts can be used directly to the designated pharmaceutical institutions that realize network settlement. If the designated pharmaceutical institution does not have the conditions for direct use, the insured person may apply for personal account payment at the medical insurance agency with relevant settlement bills. However, personal accounts shall not be used for public health expenses, sports fitness or health care consumption, which do not belong to the scope of basic medical insurance protection.

(Source: Guiyang Daily Tianyan News)

Edit: Liu Yanhong

Coordinating: Zhang Qiang

Editor: Wei Chenghua

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