The medical insurance policy in Jiangxi has changed!

July 4

Jiujiang Municipal People's Government official website released

"Implementation Opinions on Establishing and Implementing the Establishment and improvement of the basic medical insurance clinic for employees of Jiujiang City"

How to include personal accounts?

What is the scope of protection?

How much is the payment ratio?

Take a look

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1. Adjust the method of personal accounts

From January 1, 2023, personal accounts are included in the following measures, adjusting the structure of personal accounts and coordinated funds, and increasing the overall funds for outpatient protection.

On -the -job employees are included in the method. The personal account of the employee is included in the basic medical insurance premiums paid by the individual, and the standard is 2 % of the basis for the payment of the insurance payment. All the basic medical insurance premiums paid by the unit are included in the overall fund.

Flexible employment personnel are included in the method. The level of personal accounts of flexible employees is 2 % of the payment base for their participation.

Retired personnel are included in the method. The personal account of retirees is classified by the overall planning fund according to the quota, and the amount is included in the implementation of 2.5 % of the average basic pension of the province that year.

2. Clarify outpatient protection benefits treatment

From January 1, 2023, the general outpatient clinic coordination system is implemented, and the general outpatient costs are included in the overall fund payment.

Affairs. The basic outpatient expenses within the scope of drugs, medical consumables, and medical service projects that are in accordance with the national and Jiangxi provinces in the designated medical institutions in designated medical institutions.

Payment standards. In a natural year, the general outpatient clinic has a coordinated payment line of 600 yuan, and the proportion of payment within the policy scope of different levels of medical institutions is: 60 %, 55 %, and 50 % of the third level. Essence The payment ratio of employees' basic medical insurance retirement benefits has increased by 5 %, and the maximum payment limit of the year is increased to 2,000 yuan.

The Municipal Medical Security Bureau, the Municipal Finance Bureau and other departments have dynamically adjusted the general outpatient treatment treatment in accordance with the policies of their superiors and the operation of the funds, and further do a good job of effective connection of general outpatient overall planning and special chronic diseases and hospitalization.

3. Clarify the method of designing the point

Perform fixed -point management. The general outpatient medical institutions are selected by the Municipal Medical Security Bureau in the city's basic medical security designated medical institutions, and the management of medical insurance agreement is implemented to clarify the rights and rights of service scope, service content, service quality, expense settlement, service supervision, default processing, etc. Obligation relationship.

Gradually incorporate the use of drug guarantee services provided by qualified fixed -point retail pharmacies into the scope of general outpatient clinics, and support external prescriptions to purchase and settle drugs at fixed -point retail pharmacies. Explore the incorporated "Internet +" medical services that meet the conditions into the scope of general outpatient guarantee, and further give full play to the convenience and role of the outpatient guarantee system.

4. Optimization cost settlement

Insured personnel settlement. Participants should purchase medicines with electronic medical insurance vouchers (or medical insurance cards), and directly settle medical expenses in designated pharmaceutical institutions. Part of the fixed -point pharmaceutical institutions settle in accordance with the relevant regulations of the state and provinces, and municipalities.

Settlement of designated pharmaceutical institutions. The medical security agency and designated pharmaceutical institutions are settled for a year for a year. After one year of trial, the Municipal Medical Security Bureau, the Municipal Finance Bureau and other departments adjust and improve the settlement method according to the operation of the funds.

Click "Read the original text" in the lower left corner to view the full text of the "Implementation Opinions of the Office of the People's Government of Jiujiang City on Establishing and Implementing to the Establishment and Implementation of Jiujiang City Workers' Basic Medical Insurance Outpatient Clinics"

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