According to the "Detailed Rules for Implementation", the recording method of employee medical insurance personal accounts has changed. The basic medical insurance premiums paid by the unit are all included in the employee medical insurance pooling fund, and the personal accounts of on-the-job employees and insured persons are included in the standard of 2% of my insurance payment base; Retirees' personal accounts are included in the employee medical insurance pooling fund according to the quota, and the amount included is 2.8% of the average level of basic pension in Suining City in 2022.
Employees who have reached the statutory retirement age and reached the minimum payment period of Suining's basic medical insurance will be credited to their personal accounts according to the retiree policy from the next month after going through the retirement procedures and completing the liquidation procedures of medical insurance benefits. If the insured reaches the statutory retirement age, but does not reach the minimum payment period of basic medical insurance stipulated by Suining City, and chooses to continue to pay the basic medical insurance premium on a monthly basis, it will be included in the personal account according to the on-the-job personnel policy. Select the insured person who pays the basic medical insurance premium for different years at one time, and then pay it in his personal account according to the retiree policy.
The "Implementation Rules" also provides for the establishment of an overall reimbursement system for general outpatient expenses of employee medical insurance. The general outpatient expenses and drug purchase expenses of the insured in designated medical institutions and eligible retail pharmacies are included in the payment scope of the employee medical insurance pooling fund. The deductible line and the maximum payment amount are calculated cumulatively in a natural year. On-the-job employee deductible line 200 yuan, retirees deductible line 150 yuan. The medical expenses incurred by the on-the-job insured in the designated medical institutions with three-level medical insurance and qualified retail pharmacies with medical insurance shall be paid according to the proportion of 50%; The designated medical institutions with medical insurance level 2 and below are 60%. Retirees are raised according to the payment ratio of on-the-job insured persons 10%. The annual payment limit for on-the-job insured personnel is 1.200 yuan, and that for retirees is 1.500 yuan.
Our city has also established an outpatient security mechanism for patients with hypertension and diabetes (hereinafter referred to as "two diseases")-the two patients with medical insurance drugs for employees are included in the scope of outpatient drug protection for two diseases. The payment standard is: the annual limit of hypertension is 200 yuan/person, the annual limit of diabetes is 300 yuan/person, and the annual limit of two diseases is calculated together; The reimbursement rate within the policy scope is 50%.
"It is a' new dividend' for the employee health insurance reform to implement the mutual assistance guarantee for employee health insurance outpatient service, adjust the proportion of individual accounts of insured personnel every month, add the reimbursement guarantee for general outpatient service expenses and the drug guarantee for' two diseases' outpatient service, and realize the mutual assistance of insured employees, their spouses, parents and children in the individual accounts of employee health insurance. Zhang Zhiyong, Party Secretary and Director of the Municipal Medical Insurance Bureau, said that in order to promote the implementation of the policy of mutual aid for workers' medical insurance clinics, our city will further establish and improve the supervision and management mechanism, improve management service measures, innovate the system operation mechanism, guide the insured to make rational use of medical resources, ensure the safe and stable operation of the medical insurance fund, and further play the function of medical insurance to "relieve the worries of people's diseases and medical care".
(Zou Xiaquan, media reporter Li Jiawen)