Outpatient economic security system is a brand-new medical insurance system, and it is also a whole process of gradual reform and innovation. The specific content closely related to our personal interests includes four aspects.
The first is to reform and innovate the recording method of employee medical insurance personal accounts. According to the form of orderly advancement, in the future, the part paid by enterprises will not be credited to employees' personal accounts, and only a part of the funds credited to employees' personal accounts will be paid by individuals, which is actually 2% of the deposit base, which is a little lower than the original proportion.
The second is to establish a comprehensive guarantee system for outpatient expenses. In view of the fact that the part paid by the enterprise is not recorded in the personal account, it is placed under the medical insurance fund. In addition to ensuring the payment for special outpatient service and inpatient outpatient service for chronic diseases, the medical insurance fund shall be established to pay part of the expenses for general outpatient service, and the minimum development payment shall be no less than 50%. To put it simply, at least 50% of the expenses will be reimbursed by the outpatient department in the future, and 50% will be paid from the personal account.
The third is the scope of application of standard personal accounts. Personal accounts can be used to buy outpatient fees, hospitalization fees, medicines, medical machinery and medical consumables in designated pharmacies; Personal accounts can also be used to pay the medical insurance expenses of the other half, parents, children and urban and rural residents, and in some places, they can also be used to pay the mutual insurance expenses of social security cities.
The fourth is to realize the family economic security system of personal account. In addition to my application, personal account funds can also be used to purchase the medical expenses incurred by the other half of the insured, parents and children in designated hospitals and the expenses incurred by individuals in purchasing drugs, medical machinery and medical consumables in designated retail pharmacies. In other words, your personal account fee should be applied by the main family members.
To apply for a family economic account, a simple filing method must be carried out online, such as filling in the relevant contents of the main family members, such as name, fetal sex, relationship with oneself, contact telephone number, ID card and other information. Only after submitting these materials can they use the personal account assets of social security cards to pay for outpatient or hospitalization expenses for their main family members. For the cost of buying medicine in designated pharmacies, you only need to take the medicine in your own name.
At the beginning of 2022, according to the spirit of documentNo. (202 1) 14 was issued in the State Council, and specific local implementation rules were formulated throughout the country. Judging from the relevant provisions of the implementation rules throughout the country, it is basically implemented gradually from 1 in 2023, and some places can only be fully implemented in time from 2024. That's also true. Before June 5438+0, 2023, personal accounts and outpatient expenses were mostly implemented according to the previous methods.
Generally speaking, the outpatient economic security system of workers' basic medical insurance should be an employment system with basic medical insurance benefits for the insured. The main content is to reform and innovate personal accounts, improve the treatment of general outpatient services and standardize the operation of personal accounts. The construction of outpatient economic security system is of great practical significance for improving the utilization efficiency of medical insurance funds, gradually alleviating the pressure of medical expenses of insured personnel, and completing the rules and regulations more fairly and sustainably.