Recently, the website of Tianjin Medical Insurance Bureau published the Notice on Issuing the Qifubiaozhun for Outpatient (Emergency) Medical Insurance for Employees in 223 (draft for public comment) (hereinafter referred to as the Notice), and the public can put forward suggestions for revision before 18: on December 8th. Why do you tune it? How to adjust it? What will happen to medical insurance reimbursement next year? Let's take a look at it together. According to the policy background in the drafting of the Notice, the threshold for on-the-job medical insurance for employees is determined according to about 1% of the average annual salary of employees in our city announced in the previous year. In 221, the average annual salary of employees in our city was 89,736 yuan. The "Notice" mainly clarifies that in 223, the on-the-job employees, retirees under 7 years old and retirees over 7 years old (inclusive) will be 9 yuan, 8 yuan and 75 yuan respectively. From January 1, 223, the medical insurance reimbursement for employees will be improved: the medical expenses borne by individuals within the policy scope of the insured person's outpatient (emergency) medical treatment will be included in the reimbursement scope of employee's serious illness insurance; Improve the reimbursement ratio of each expense segment of employee's serious illness insurance by 5 percentage points. Notice on Issuing the Qifubiaozhun for Outpatient (Emergency) Medical Insurance for Employees in 223 According to the Notice of the General Office of Tianjin Municipal People's Government on the Implementation Measures for Improving the Economic Security System for Outpatients with Basic Medical Insurance for Employees (Jin Zheng Ban Gui [221] No.16), the relevant matters are hereby notified as follows: In 223, the Qifubiaozhun for employees with basic medical insurance is 9 yuan, and the retirees under 7 years old are. Policy Interpretation 1. What is the threshold for medical insurance for employees? Qifubiaozhun for medical insurance for employees (emergency) is commonly known as "Qifubiaozhun". The medical expenses within the scope of medical insurance reimbursement incurred by employees' medical insurance insured persons for emergency medical treatment shall be reimbursed by the medical insurance fund according to the prescribed proportion after they have to bear part of them first. The standard of medical expenses paid by individuals first is the "deductible line" for outpatient (emergency) diagnosis. Second, in 222, what is the deductible standard for medical insurance for employees in our city? What is the national level? In 222, the on-the-job employees, retirees under 7 years old and retirees over 7 years old will be 8 yuan, 7 yuan and 65 yuan respectively. Compared with Beijing, Shanghai and other relevant provinces and cities that have implemented general outpatient reimbursement, the deductible standard of medical insurance for employees in our city is relatively low. Three, why should we adjust the medical insurance door (emergency) qifubiaozhun in our city? According to the "Notice of the General Office of Tianjin Municipal People's Government on Improving the Implementation Measures of the * * * Economic Security System for Employees' Basic Medical Insurance Outpatients", the Qifubiaozhun for on-the-job employees' medical insurance in our city is determined according to about 1% of the average annual salary of employees in our city published in the previous year, and a dynamic adjustment mechanism for the Qifubiaozhun for employees' medical insurance is established. The adjustment and release of the Qifubiaozhun in 223 is a work measure to implement the relevant provisions of the Municipal People's Government, and is conducive to playing the role of the "first pass" for reimbursement of Qifubiaozhun, guiding the rational medical consumption of outpatients and preventing fraudulent insurance. 4. Are there any new changes in the reimbursement treatment for medical insurance (emergency) clinics for employees in 223? From January 1, 223, the medical expenses borne by individuals within the policy scope of employee medical insurance (emergency) consultation will be included in the reimbursement scope of employee serious illness insurance. That is to say, the expenses after medical insurance reimbursement below the maximum payment limit (9 yuan) of medical insurance for employees (emergency) and the medical expenses borne by individuals above can be reimbursed "twice" by employees' serious illness insurance according to regulations. V. Are there any new changes in the medical insurance reimbursement for employees in 223? From January 1, 223, the reimbursement rate of each expense segment of employee's major illness insurance will be increased by 5 percentage points, that is, the minimum payment standard will be adjusted to 1, (inclusive), 1,-2, (inclusive) and 2,-3, (inclusive) from 6%, 65% and 7% to 65%, 7% and 75%, which will be further reduced. Drafting instructions The drafting of the Notice on Issuing the Qifubiaozhun for Outpatient (Emergency) Medical Insurance for Employees in 223 (hereinafter referred to as the Notice) is as follows: 1. Policy Background The Notice of the General Office of Tianjin Municipal People's Government on Improving the Implementation Measures for the Economic Security System for Employees' Basic Medical Insurance Outpatients (Jin Zheng Ban Gui [221] No.16) stipulates that, The Qifubiaozhun for on-the-job workers' medical insurance is determined according to about 1% of the average annual salary of workers in our city published in the previous year. The Qifubiaozhun for on-the-job workers under 7 years of age and retirees over 7 years of age (inclusive) is lower than that of on-the-job workers in 1 yuan and 15 yuan respectively. In 222, the Qifubiaozhun for on-the-job personnel, retirees under 7 years old and retirees over 7 years old (inclusive) will continue to be 8 yuan, 7 yuan and 65 yuan; In the following years, the Municipal Medical Security Bureau shall, jointly with the Municipal Finance Bureau, determine it on an annual basis and report it to the Municipal People's Government for approval and release. At the same time, according to the Notice of Municipal Bureau of Social Security, Municipal Bureau of Medical Insurance and Municipal Taxation Bureau on Promulgating the Average Wage of Employees in the City in 221 and the Standards of Wages and Benefits in 222 (No.19 [222] of Tianjin People's Social Security Bureau), the average annual wage of employees in our city in 221 was 89,736 yuan. II. The main contents of the Notice are based on the provisions of the documents of the Municipal People's Government and the average annual salary of employees in this Municipality. The Notice mainly clarifies that in 223, employees with medical insurance threshold (emergency) Qifubiaozhun, retirees under 7 years of age and retirees over 7 years of age (inclusive) are 9 yuan, 8 yuan and 75 yuan respectively. Iii. Other matters that need to be explained According to the Notice of the Municipal Medical Insurance Bureau and other four departments on doing a good job in the basic medical security for urban and rural residents in 222 (No.61 [222] of Tianjin Medical Insurance Bureau), the medical insurance reimbursement treatment for employees will be improved from January 1, 223. On the one hand, the medical expenses borne by the insured within the policy scope of emergency medical treatment are included in the reimbursement scope of employee's serious illness insurance. On the other hand, increase the reimbursement rate of employees' major illness insurance by 5 percentage points, further reduce the burden of medical expenses for insured people to see a doctor and prevent poverty and return to poverty due to illness. Before 18: on December 8, 222, the public can put forward amendments in the following ways: please send feedback by email to sybjdybzc@ letter, please mail it to the treatment security office, No.81 Xianyang Road, Nankai District, Tianjin, and mark the words "employees' medical insurance for advice" on the envelope.