Legal analysis: 1. Incorporate more outpatient expenses into medical insurance reimbursement, and include some outpatient expenses for chronic and special diseases, frequently-occurring diseases and common diseases that are harmful to health and bear heavy expenses into the overall fund payment. Within the scope of the policy, the proportion of payment will start from 5%, and it will be inclined to retirees appropriately. In the future, the level of protection will be gradually improved with the strengthening of the fund's affordability.
2. All the unit contributions are included in the overall planning fund, and the individual contributions of the employees are still included in their personal accounts. The personal accounts of retirees are included in the overall planning fund according to the quota, and the amount is gradually adjusted to about 2% of the average basic pension level in the year when the reform was implemented in the overall planning area. After the adjustment of the unified account structure, the funds transferred to individual accounts are mainly used to support and improve the outpatient economic security and improve the outpatient treatment.
3. Personal accounts can be used by family members, allowing family members to give * * * money, which can be used to pay for medical treatment in designated medical institutions and purchase medicines, medical devices and medical consumables in designated retail pharmacies, and explore personal contributions for family members to participate in basic medical insurance for urban and rural residents.
4. Strengthen the supervision and management of medical insurance funds, improve the auditing and internal control systems, severely investigate and deal with illegal behaviors such as false hospitalization and fraudulent insurance, and improve the payment mechanism that is suitable for outpatient economic security.
Legal basis: Article 22 of the Regulations of the People's Republic of China on the Basic Medical Insurance for Urban Workers
No cash may be withdrawn from an individual account, no overdraft may be allowed, and the surplus shall be accumulated for use. When employees and retirees die, the balance of funds in their personal accounts can be inherited.
article 23 an employer shall not increase the personal account funds for its employees or other personnel in violation of the provisions of these regulations.
article 24 social insurance agencies shall establish basic medical insurance files for employees and retirees and issue basic medical insurance certificates.
Twenty-fifth people who move out of this province or flow in this province can transfer the fund balance in their personal accounts; If it cannot be transferred, it shall be returned to me. The basic medical insurance premium included in the overall planning fund shall be owned by all the insured personnel of the original overall planning unit, and shall not be transferred or refunded.