The regulations will be implemented from January 1, 2023. The specific content is as follows: Dalian employee medical insurance insured persons shall coordinate general outpatient medical expenses within the scope of the medical insurance policy incurred by insured persons in designated medical institutions.

(hereinafter referred to as ordinary outpatient medical expenses) shall be paid by the Employee Medical Insurance Co-ordination Fund according to the following standards: Note: The payment ratio of the Employee Medical Insurance Co-ordination Fund to persons enjoying retirement benefits shall be increased by 5 percentage points.

If the insured person signs an upgrade service package with a family doctor in a primary medical institution and receives treatment at the contracted primary medical institution, the payment ratio of the employee medical insurance coordinating fund will be increased by 10 percentage points.

Outpatient Chronic Disease (1) Benefit Policy 1. The medical expenses incurred by insured persons for outpatient treatment of chronic diseases at designated medical institutions within the scope of the medical insurance policy shall be included in the coverage of outpatient chronic diseases.

The catalog of chronic and special diseases in outpatient clinics in our city, the benefit enjoyment period, and the level of benefits are implemented in accordance with regulations (the table below).

2. The scope of cost protection for some chronic and special diseases that are unified and standardized across the province shall be implemented in accordance with the regulations of Liaoning Province.

High-value drugs that are settled separately by medical insurance are not included in the coverage of outpatient chronic disease expenses.

3. Insured patients can enjoy the benefits of multiple outpatient chronic diseases at the same time, but the benefits of subdivided diseases under the same disease cannot be enjoyed at the same time.

Outpatient chronic disease benefits and general outpatient overall benefits can be combined.

An outpatient medical expense can only be paid according to one benefit.

If the insured person enjoys outpatient chronic disease benefits midway, the maximum payment limit for the year will be calculated on a monthly basis.

The maximum annual payment limit for outpatient chronic diseases is the total payment amount of basic medical insurance and supplementary medical insurance.

Dialysis-related expenses incurred during hospitalization are included in the hospitalization fee and reimbursed according to hospitalization standards.

(2) Benefit period: If the outpatient treatment benefit period for chronic and special diseases expires and the qualification for benefits is terminated, but still needs to continue treatment, you should apply for recognition again.

For patients with chronic diseases whose benefit period is long-term or five years, and who have not incurred compliant medical expenses for 24 consecutive months after identification, their qualifications for benefits will be suspended.

(3) Handling services: Insured persons must undergo medical examination and confirmation before they can enjoy outpatient chronic disease treatment.

(4) Dialysis settlement method: Outpatient dialysis fees are settled using the medical insurance coordinating fund according to the monthly capitation payment standard with designated medical institutions in the coordinating area, and are balanced in half a year. Overspending will not be compensated, and the balance will be retained reasonably.

The employee medical insurance pooling fund’s monthly lump sum quota per person is 7,300 yuan. If the insured’s actual pooling fund payment at a designated medical institution is less than 90% of the total lump sum quota, the settlement shall be based on the actual amount incurred; if it exceeds 90% or above,

Settlement will be based on the total fixed quota per capita.

Other matters (1) Benefits for the original outpatient prescribed diseases that are not included in the scope of outpatient chronic diseases, outpatient designated drug supply, outpatient surgeries, prenatal examinations, outpatient family planning surgeries, and emergency rescue and discharge benefits are merged into general outpatient clinics

Coordinate benefits and uniformly implement expense guarantees.

Inpatient family planning surgeries are covered by medical insurance hospitalization benefits.

A transitional policy will be implemented for prenatal examination fees. Those who give birth on or before September 30, 2023, can also receive the fixed subsidy for the original prenatal examination fees; those who give birth on or after October 1, 2023, will no longer enjoy the fixed subsidy for prenatal examination fees.

Subsidies.

(2) Medical treatment in other places. Employees’ medical insurance participants who live in other places for a long time in accordance with regulations will enjoy the general outpatient insurance and outpatient chronic and special disease benefits of employee medical insurance in accordance with the city’s treatment standards in the registered long-term residence area.

Employees insured by employee medical insurance who seek medical treatment temporarily in other places will not enjoy the general outpatient benefits of employee medical insurance at the place of medical treatment, but will enjoy outpatient chronic and special disease treatment according to the city's treatment standards.

The insured person’s dialysis treatment in other places will be reimbursed at a limit of 7,300 yuan per month.

(3) Other situations: When insured persons dispense prescriptions at Internet medical prescription circulation pharmacies, the employee medical insurance coordinating fund payment standard is determined according to the level of the designated medical institution that issues the prescription.

The outpatient medical expenses incurred by insured persons in designated Internet medical institutions and offline outpatient medical expenses are combined and calculated, and the payment standard of the employee medical insurance pooling fund is determined according to the level of the entity designated medical institution that the designated Internet medical institution relies on.

If the insured person enjoys the general outpatient overall treatment in the middle, the minimum payment standard and payment limit shall be based on the annual standard.

After the implementation of the new policy, what changes have occurred in the overall outpatient benefits of employee medical insurance in our city? First, the level of employee medical insurance outpatient protection is higher.

General outpatient medical expenses incurred in designated outpatient medical institutions at all levels can be paid from the medical insurance pooling fund on a proportional basis, with the upper limit of payment in a natural year being 12,000 yuan.

Second, employee medical insurance outpatient coverage is more equitable and inclusive.

Patients with chronic diseases no longer need to undergo medical examination to enjoy outpatient medical expense protection.