Spread!Zhuozhou town employee health insurance general outpatient service has been carried out!Specific benefits…

2022-06-16 0 By

Zhuozhou City Medical Security Bureau on the development of urban workers basic medical insurance general outpatient service as a whole, all insured units, insured personnel: in accordance with baoding City medical Security Bureau and other six departments of the notice on printing and distributing spirit.From 2022, the basic medical insurance for urban workers in Zhuhai will carry out general outpatient service pooling.At present the city level 2 and above medical institutions (the second central hospital, zhuozhou city of baoding city hospital, zhuozhou Chinese medicine hospitals, zhuozhou, women’s and children’s hospital cancer hospital, a state in hebei baoding zhuozhou witchford hospital, zhuozhou city, baoding zhuozhou long and children’s hospital maternity hospital) has been running average outpatient service as a whole settlement business.◆ In a medical insurance business year, the minimum pooling standard for general outpatient service is 100 yuan;◆ The proportion of payment within the scope of the policy for on-the-job workers is 50%, the proportion of payment within the scope of the policy for retired workers is 60%, the annual maximum payment limit is: on-the-job insured personnel 900 yuan, the retired insured personnel 1200 yuan.The reimbursement of general outpatient consultation fee is not recorded in the general outpatient pooling payment limit.Insured personnel in general outpatient service as a whole, outpatient treatment of chronic disease can be enjoyed at the same time, prescription should be issued respectively when seeing a doctor, respectively settlement.Zhuozhou City Medical Security Bureau on February 16, 2022 on the implementation of the Detailed rules on the Establishment and improvement of urban employees basic medical insurance outpatient mutual aid security mechanism, you want to know the policy interpretation in this policy interpretation is to further improve the mutual aid, shared responsibility of the basic medical insurance for employees (hereinafter referred to as the employee medical insurance) system,To better solve the problem of outpatient insurance for employees covered by medical insurance and effectively reduce the burden of their outpatient medical expenses, Baoding Medical Security Bureau, together with relevant municipal departments, issued the Implementation Rules on Establishing and Improving the Mutual Aid Insurance Mechanism for Urban Employees’ Basic Medical insurance (hereinafter referred to as the Rules).1. Drafting Background and Policy Basis To establish and improve the mutual aid security mechanism of employee medical insurance outpatient service is the task deployment clearly proposed by the state and province to deepen the reform of medical security system.Since the establishment of the employee medical insurance, the implementation of the overall planning fund and individual account combined mode, “overall planning fund to ensure hospitalization and outpatient serious illness, individual account to ensure outpatient minor illness”.With the development of social economy and the improvement of people’s demand, the limitation of personal account is gradually highlighted.At present, some of the common diseases and frequently-occurring diseases of insured personnel are often seen in outpatient clinics, especially in the elderly group.Individual account safeguard function is insufficient, fraternization sex is not enough, “sick is not enough, do not have disease cannot be used”, cause the idle of medical insurance fund, do not have the effect of mutual aid.Still exist additionally the phenomenon that lawless element carries out fraud to cheat protect.On April 13, 2021, issued by The General Office of the State Council “about establishing and perfecting the worker is basic medical treatment insurance of outpatient service in all aid security mechanism for the guidance of”, the provincial government in September 2021 issued “on establishing and perfecting the worker outpatient service of insurance of primary medical treatment measures for the implementation of all aid safeguard mechanism, puts forward the work requirements of each plan as a whole area, for reform of individual account,Establish a system for coordinating outpatient services.Second, the drafting process health bureau of baoding city combined with the baoding city in recent years, the worker medical insurance fund operation and related data, a detailed analysis to measure and reference for other cities treatment standards, drafted on establishing and perfecting the basic medical insurance for urban workers outpatient service in all aid the regulations for the implementation of the safeguard mechanism, for the various counties (city, area) medical security departments and straight related departments,At the same time, baoding Municipal People’s Government through the website to solicit public opinions for 30 days, the document was further revised and improved, by Baoding Municipal Justice Bureau for legitimacy review.Approved by the sixth executive meeting of Baoding Municipal Government on December 15, officially issued and implemented.The Detailed Rules consists of seven chapters and 35 articles, which are divided into general provisions, personal account management, mutual assistance treatment for outpatient service, medical service and medical treatment management, medical expense reimbursement and settlement, supervision and management, and supplementary provisions.The first chapter is the general provisions, mainly elaborated the purpose, basis and principle of the establishment of outpatient mutual aid security mechanism, and clarified the implementation scope and department responsibilities.The second chapter is the management of personal accounts, which stipulates the entry method and use scope of personal accounts.Account of on-the-job worker individual is planned by insurance premium of individual pay of primary medical treatment, plan into standard is oneself ginseng keep the 2% of capture cost base, the insurance premium of primary medical treatment of unit pay plans as a whole plan fund.Retired employees’ personal accounts shall be allocated by the pooling fund in accordance with a fixed amount, and the amount allocated for retirees of government organs and public institutions shall be 2% of the average basic pension level of retirees of government organs and public institutions in Baoding city in 2021, and the amount allocated for retirees of enterprises shall be 2% of the average basic pension level of retirees of enterprises in Baoding City in 2021.Chapter three is the mutual aid treatment of outpatient service.A new general clinic coordination system.In business of business of insurance of a medical treatment year inside, rise to pay standard is 100 yuan, on-the-job worker submits an expense account scale 50%, retired worker submits an expense account scale 60%, annual highest pay limitation is on-the-job worker 900 yuan, retired worker 1200 yuan.The fourth chapter is about medical service and management.Relevant regulations are made on the management of medical treatment and designated management of medical institutions.The fifth chapter is management and supervision.They are as follows :(1) improve management service measures and guide the rational utilization of medical resources.(2) Establish a dynamic management mechanism for the whole process of personal accounts.3. Establish a safety prevention and control mechanism for medical insurance funds.(4) Improve the medical service monitoring, analysis and assessment system.Chapter VI Supplementary Provisions.Four, related term explanation worker medical insurance outpatient mutual aid security reform to say simply, go to a doctor worker medical insurance the outpatient service that ginseng protects a person before basically pass “individual account” the way to safeguard, now is through “mutual aid security”, namely outpatient service as a whole will reimburse expenses.The main consideration of changing the mode of outpatient insurance to mutual aid and reimbursement is to improve the efficiency of the use of medical insurance fund, so as to improve the level of outpatient treatment of the insured.