The scope of the population to which the "Implementation Rules" apply: persons participating in the basic medical insurance for employees at the same level in the autonomous region.
Credit ratio of personal accounts: Starting from October 1, 2022, all basic medical insurance premiums paid by participating units will be credited to the overall fund.
In the personal accounts of active employees, basic medical insurance premiums paid according to 2% of the insured payment base are included.
The personal accounts of retirees will be gradually adjusted to be transferred from the overall fund according to fixed amounts. Starting from October 1, 2022, based on the average basic pension in the region in 2021, the personal accounts will be transferred at a rate of 3%.
2% will be transferred to personal account.
After adjusting the overall pooling fund and individual account structures, the increased pooling fund is mainly used for outpatient financial security and to improve the outpatient benefits of insured persons.
Scope of use of personal accounts: Personal accounts are mainly used to pay out-of-pocket expenses incurred by insured persons within the scope of the policy at designated medical institutions or retail pharmacies.
It can be used to pay the personally borne medical expenses incurred by the insured person, his spouse, parents, and children for medical treatment at designated medical institutions, as well as the personally borne expenses incurred by purchasing drugs, medical equipment, and medical consumables at designated retail pharmacies.
It can also be used for individual contributions for spouses, parents, and children to participate in resident medical insurance, large medical expense subsidies for employees, long-term care insurance, etc.
Personal accounts shall not be used for expenditures such as public health expenses, sports fitness or health care consumption that are not covered by basic medical insurance.
General outpatient service coverage: When insured persons visit designated medical institutions, the medical expenses that are within the scope of the medical insurance policy will be included in the scope of general outpatient care coverage.
When insured persons enjoy the general outpatient co-ordination treatment, they must use valid vouchers such as medical insurance electronic vouchers and social security cards for settlement. The cumulative payment of medical expenses within the scope of the policy by personal account funds and cash in one year exceeds 1,000 yuan, and the co-ordination fund will be paid in proportion.
, the payment ratio for third-level medical institutions is 60%, the payment ratio for second-level and lower medical institutions is 80%, and the payment ratio for retirees increases by 5 percentage points.
The maximum annual payment limit is 5,000 yuan for active employees and 6,000 yuan for retirees.
The financial use of personal accounts by family members is not included in the overall minimum payment standard for general outpatient clinics.
The overall payment limit for general outpatient clinics is included in the maximum payment limit of the annual overall fund.