The personal account method of employee medical insurance ushered in reform. Employee medical insurance personal accounts are only included in individual contributions, and the inclusion standard is 2% of the base of my insured contributions. The unit payment is no longer included, and all of them enter the employee medical insurance pooling fund.
Retirees' personal accounts will continue to be included in the overall fund quota, with specific criteria as follows: under 70 years old 100 yuan per month, and over 70 years old 1 10 yuan.
For on-the-job employees, after the unit payment is no longer included, the money entering the personal account becomes less. Retirees have remained basically unchanged.
2, the realization of personal account funds earmarked.
As we all know, at present, the money in the personal account of Beijing employees' medical insurance can be withdrawn, because the money has entered the personal medical insurance passbook and can be withdrawn in the bank.
The "Implementation Measures for Improving the Economic Security Mechanism of the Basic Medical Insurance Outpatients in Beijing" issued this time clearly proposes to improve the management measures for the use of personal accounts, establish a dynamic management mechanism for the whole process of personal accounts, strengthen the audit of the use and settlement of personal accounts, realize the earmarking of personal account funds, and improve the efficiency of the use of medical insurance funds.
The money in personal account can be used by family members.
According to the implementation measures, the money in the personal account is mainly used to: pay the out-of-pocket expenses of the insured within the policy scope of designated medical institutions or designated retail pharmacies; Pay the medical expenses incurred by the insured and their spouses, parents and children in designated medical institutions and borne by individuals; Personal expenses incurred in purchasing drugs, medical devices and medical consumables at designated retail pharmacies.
So if you can't run out of money in your employee medical insurance personal account, you can give it to your spouse, parents and children in the future. Of course, it needs to be clarified that what is said here is that the money in the personal account can be used by the family, not the social security card, and the personal social security card cannot be used by anyone else.
4. Improve the medical insurance system.
Outpatient medical expenses incurred by employees' medical insurance insured, Qifubiaozhun, payment ratio and maximum payment limit of medical insurance fund, outpatient chronic disease and special disease protection, outpatient drug protection of designated retail pharmacies, medical insurance payment of "internet plus" medical services and other related policies shall be implemented in accordance with the provisions of basic medical insurance.
Actively promote the pilot project of paying for chronic diseases such as hypertension and diabetes in some primary medical institutions from paying by medical items to paying by head; Gradually expand the scope of designated medical institutions for direct settlement of outpatient expenses in different places, and realize the requirements of direct settlement of general outpatient and emergency expenses across provinces in designated medical institutions in the city.
Legal basis:
Measures of Beijing Municipality on Improving the Outpatient Security Mechanism of Basic Medical Insurance.
(3) Improve the personal account calculation and payment methods. Personal accounts of employees are included in the basic medical insurance premiums paid by individuals, and the inclusion standard is 2% of the insured payment base. The basic medical insurance premiums paid by the unit are all included in the employee medical insurance pooling fund. Retirees' personal accounts will continue to be included in the overall fund quota. Specific inclusion criteria are: those under 70 years old are included in the 100 yuan/month standard, and those over 70 years old (inclusive) are included in the 1 10 yuan/month standard. When the above standards need to be adjusted, the Municipal Medical Insurance Bureau in conjunction with the Municipal Finance Bureau will study and put forward an adjustment plan, which will be promulgated and implemented after being approved by the municipal government.
(4) standardize the use and management of personal accounts. Improve the management measures for the use of personal accounts, establish a dynamic management mechanism for the whole process of personal accounts, strengthen the audit of personal account use and settlement, realize the earmarking of personal account funds, and improve the efficiency of the use of medical insurance funds. Personal accounts are mainly used to pay out-of-pocket expenses of insured persons within the policy scope of designated medical institutions or designated retail pharmacies; It can be used to pay the medical expenses incurred by the insured and their spouses, parents and children in designated medical institutions, as well as the expenses incurred by individuals in purchasing drugs, medical devices and medical consumables in designated retail pharmacies; Support the purchase of commercial health insurance products connected with basic medical insurance in this city. Explore personal accounts to pay the personal contributions of the insured and their spouses, parents and children to participate in the basic medical insurance and long-term care insurance for urban and rural residents in this city. Personal accounts shall not be used for public health expenses, physical fitness or health care consumption and other expenses that are not covered by the basic medical insurance.
(five) to enhance the ability of outpatient service. Outpatient medical expenses incurred by employees' medical insurance insured, Qifubiaozhun, payment ratio and maximum payment limit of medical insurance fund, outpatient chronic disease and special disease protection, outpatient drug protection of designated retail pharmacies, medical insurance payment of "internet plus" medical services and other related policies shall be implemented in accordance with the provisions of basic medical insurance. Constantly improve the medical insurance outpatient service and serious illness protection policy for employees. Need to adjust, by the Municipal Medical Insurance Bureau in conjunction with the Municipal Finance Bureau to study and put forward the adjustment plan, approved by the municipal government and promulgated for implementation.
(6) Improve management service measures. Implement the requirements of the state on the management of designated medical institutions, improve the dynamic management of designated medical institutions in this city, and provide appropriate medical services and pharmaceutical services for the insured. Through effective measures such as supporting the construction of primary medical service system, improving family doctor contract service, and standardizing long-term prescription management, the insured will be guided to seek medical treatment for the first time at the primary level.
(seven) accelerate the direct settlement of outpatient expenses across provinces. Cooperate with the construction of a unified national medical security information platform, gradually expand the scope of designated medical institutions for direct settlement of outpatient expenses in different places, and realize the full coverage of direct settlement of general outpatient and emergency expenses in designated medical institutions in the city. Do a good job in inter-provincial direct settlement of chronic diseases and special diseases in outpatient departments.
(eight) improve the payment mechanism to adapt to outpatient service. Strengthen the comprehensive budget management of medical insurance funds, construct and improve the quality evaluation system of medical institutions with comprehensive budget, and improve the management quality and level of medical institutions by medical insurance departments. Actively promote the pilot project of paying for chronic diseases such as hypertension and diabetes in some primary medical institutions from paying by medical items to paying by head; Study and explore the combined payment method for outpatients; For outpatient expenses that are not suitable for package payment, they can be paid by project. In accordance with national requirements, scientifically and reasonably determine the payment standard of medical insurance drugs, and guide medical institutions and patients to take the initiative to use drugs with definite curative effect and reasonable price.
(nine) to strengthen the supervision and management of medical insurance funds. Strictly implement the budget management system of medical insurance fund, and strengthen the construction of fund audit system and internal control system. Strict implementation of the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds", the establishment of a safety prevention and control mechanism for medical insurance funds, strengthening the supervision of medical behaviors and medical expenses, guiding designated medical institutions to standardize the provision of medical services, and severely investigating and dealing with illegal acts such as "hanging beds" and inducing hospitalization. Severely crack down on fraud and insurance fraud to ensure the safe, efficient and rational use of funds.