Why do you want to tune it? How to adjust it?
What will happen to medical insurance reimbursement next year?
Let's take a look together.
According to the policy background when the Notice was drafted, the Qifubiaozhun for medical insurance outpatient (emergency) consultation for employees was determined according to about 1% of the average annual salary of employees in our city published last year. 202 1 year, the average annual salary of employees in our city is 89736 yuan.
The Notice mainly clarifies that in 2023, employees, retirees under 70 years old and retirees over 70 years old will be 900 yuan, 800 yuan and 750 yuan respectively.
From June 5438+1 October1day, 2023, the reimbursement of employees' medical insurance will be improved: the medical expenses borne by individuals within the outpatient (emergency) medical treatment policy of the insured will be included in the reimbursement of employees' serious illness insurance; Increase the reimbursement ratio of each expense segment of employee's serious illness insurance by 5 percentage points.
On the liberalization of basic medical insurance for employees in 2023
Notice of Qifubiaozhun for outpatient (emergency) consultation
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 (No.2026543816), relevant matters are hereby notified as follows:
In 2023, the minimum payment standard of basic medical insurance for employees will be 900 yuan, 800 yuan for retirees under 70 years old and 750 yuan for retirees over 70 years old.
Policy interpretation
1. What is the threshold for employee medical insurance (emergency)?
Qifubiaozhun (emergency) of employee medical insurance is commonly known as "Qifubiaozhun". The medical expenses within the scope of medical insurance reimbursement incurred by the employee's medical insurance insured due to emergency shall be reimbursed by the medical insurance fund according to the prescribed proportion after the part that needs to be borne first. The standard of medical expenses paid by individuals in advance is the "deductible line" for outpatient (emergency) diagnosis.
2. What is the deductible standard of medical insurance for employees in our city in 2022? What is the national level?
In 2022, the employees, retirees under 70 years old and retirees over 70 years old will be 800 yuan, 700 yuan and 650 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 of medical insurance for employees in our city is determined according to about 1% of the average annual salary of employees in our city published last year, and a dynamic adjustment mechanism of the Qifubiaozhun of medical insurance for employees is established. The adjustment and release of Qifubiaozhun in 2023 is a work measure to implement the relevant provisions of the Municipal People's Government, which is conducive to playing the role of "first pass" for reimbursement of Qifubiaozhun, guiding outpatients to rational medical consumption and preventing fraudulent insurance.
4. Are there any new changes in the reimbursement treatment for medical insurance (emergency) clinics for employees in 2023?
From June 5438+1 October1day in 2023, the medical expenses borne by individuals within the scope of employee medical insurance (emergency) policy will be included in the reimbursement scope of employee serious illness insurance. That is to say, the expenses after medical insurance reimbursement for employees whose medical insurance (emergency) is below the maximum payment limit (9000 yuan) and the medical expenses borne by above individuals can be reimbursed by employees' serious illness insurance "twice" according to regulations.
Verb (abbreviation of verb) Is there any new change in employee medical insurance reimbursement in 2023?
From June 5438+1 October1in 2023, the reimbursement rate of each expense segment of employee's serious illness insurance increased by 5 percentage points, that is, the minimum payment standard was 6.5438 million (inclusive), and the reimbursement rate of 6.5438 million to 200,000 (inclusive) and 200,000 to 300,000 (inclusive) was 60%.
Drafting instructions
The Notice on Printing and Distributing the Qifubiaozhun for Employees' Basic Medical Insurance in 2023 (hereinafter referred to as the Notice) is drafted as follows:
I. Policy background
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 (JZ [20265438]16) stipulates that the Qifubiaozhun for employees' medical insurance on-the-job personnel is determined according to 1% of the average annual salary of employees in our city published last year, and they are under 70 years of age. In 2022, the Qifubiaozhun for employees, retirees under 70 years old and retirees over 70 years old (inclusive) will continue to be 800 yuan, 700 yuan and 650 yuan; The following years shall be determined by the Municipal Medical Security Bureau in conjunction with the Municipal Finance Bureau on an annual basis and reported to the Municipal People's Government for approval and release. At the same time, according to the Notice of Municipal Taxation Bureau of Municipal Medical Insurance Bureau of Municipal People's Social Security Bureau on Promulgating the Average Wage of Employees in 20021Year and the Wage and Welfare Standards for 2022 (No.9 of Tianjin People's Social Security Bureau [2022]1Year), the average annual wage of employees in our city in 20021Year was 89,736 yuan.
Two. Main contents of the notice
According to the documents of the Municipal People's Government and the average annual salary of employees in this city, the Notice mainly clarifies that in 2023, employees with medical insurance threshold (emergency), retirees under 70 years old and retirees over 70 years old will be 900 yuan, 800 yuan and 750 yuan respectively.
Three. 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 Basic Medical Security for Urban and Rural Residents in 2022 (Tianjin Medical Insurance Bureau [2022] No.6 1), the medical insurance reimbursement benefits for employees will be increased from1in 2023. On the one hand, the medical expenses borne by the insured within the scope of the emergency medical policy are included in the reimbursement scope of the employee's serious illness insurance. On the other hand, increase the reimbursement rate of employees' serious 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.