In addition, from now on, the city will add 897 designated medical institutions for medical insurance.
The qifubiaozhun for medical insurance for serious illness of people in difficulty is reduced by 50%.
Starting from June 65438+1 October1day, the threshold of medical insurance for serious illness in this city was adjusted to 30404 yuan. After the city's basic medical insurance participants enjoy the basic medical insurance benefits, the medical expenses within the scope of the basic medical insurance policy are paid by individuals, and the part exceeding the Qifubiaozhun for serious illness medical insurance is included in the medical insurance coverage for serious illness. The object of serious illness medical insurance is the basic medical insurance for urban workers and urban and rural residents in this city. The medical insurance for serious illness is paid by the basic medical insurance fund for urban workers and urban and rural residents respectively.
The city's medical insurance for serious illness is subject to "subsection calculation and cumulative payment". For the part above Qifubiaozhun (excluding), if the individual pays medical expenses within 50,000 yuan (including), 60% will be paid by the basic medical insurance fund; If the individual pays more than 50,000 yuan for medical expenses, 70% will be paid by the basic medical insurance fund, with no upper limit. For poor dependents, minimum living security objects, people with financial difficulties, urban and rural low-income family rescuers and other needy people, the minimum qifubiaozhun for serious illness medical insurance is reduced by 50%, and the medical expenses paid by individuals above the minimum qifubiaozhun (excluding) are accumulated within 50,000 yuan (including), and 65% is paid by the basic medical insurance fund; Personal medical expenses exceeding 50,000 yuan shall be paid by the basic medical insurance fund by 75%.
Single medical materials 1000 yuan or less shall be reimbursed.
From June 5438+1 October1day in 2023, the reimbursement standard of medical materials for basic medical insurance will also be adjusted: First, the standard of including all personal expenses in the scope of medical insurance payment will be adjusted, from the original 500 yuan to 1000 yuan; Second, the proportion included in the payment scope of basic medical insurance has been adjusted. The proportion of medical materials with a single cost 1 000 yuan (inclusive) included in the basic medical insurance payment range increased from 70% to 80%, and the corresponding personal burden ratio decreased from 30% to 20%.
The scope of implementation of the new policy covers the basic medical insurance personnel of this Municipality, including the urban workers' basic medical insurance personnel and the urban and rural residents' basic medical insurance personnel. Medical personnel at public expense in this Municipality shall refer to the implementation. This policy adjustment does not include artificial organs, and artificial organs are subject to the original reimbursement policy. In addition, when the insured persons of basic medical insurance use the products selected in centralized procurement, they shall be subject to the medical insurance reimbursement policy for the products selected in centralized procurement.
There is no threshold for medical assistance.
Since June 65438+1 October1in 2023, there is no qifubiaozhun for medical assistance in this city. The outpatient and inpatient medical expenses borne by individuals within the scope of reimbursement of basic medical insurance are all included in the scope of medical assistance in this Municipality. Medical assistance comprehensively covers employees who have registered in this city and participate in the basic medical insurance, urban and rural residents with heavy medical expenses, and social assistance objects such as poor, low-income and low-income people who participate in the basic medical insurance as recognized by the civil affairs department. At the same time, the social assistance objects participating in employee medical insurance and resident medical insurance are given equal assistance.
After deducting the basic medical insurance, serious illness insurance, commercial insurance reimbursement and all kinds of assistance, the personal burden within the policy scope will be given medical assistance in stages according to the proportion of 30% below 30,000 yuan, 40% above 30,000 yuan to 50,000 yuan (inclusive) and 50,000 yuan.
757 kinds of hospital preparations included in medical insurance
The Municipal Medical Insurance Bureau, together with the Municipal People's Social Security Bureau, included 757 kinds of hospital preparations produced by 34 designated medical institutions in this city into the reimbursement catalogue of hospital preparations, covering the designated medical institutions with basic medical insurance in this city, as well as the basic medical insurance for all urban workers and urban and rural residents. The catalogue was officially implemented on June 65438+ 10/day, 2023.
Hospital preparations are subject to payment standard management, and hospital preparations whose sales price is not higher than the payment standard are included in the payment scope of medical insurance fund and industrial injury insurance fund. The varieties of hospital preparations included in the Catalogue of Hospital Preparations Reimbursement can only be included in the scope of medical insurance fund payment if they are declared to be used by designated medical institutions in principle. The reimbursement ratio is implemented with reference to Class A drugs and included in the general budget management.
In addition, the Municipal Medical Insurance Bureau included 897 medical institutions, including Shuguang Community Health Service Center in Haidian District, Baicaoyuan Chinese Medicine Hospital in Beijing and Jiansheng Nursing Home Clinic in Chaoyang District, into the agreement management of designated medical institutions in this city, and signed a service agreement for designated medical institutions for medical insurance, providing medical insurance services for the insured from June 5438 to February 3, 2022.