"When will the COVID-19 vaccine be fully available?" "Can nucleic acid testing be reimbursed by medical insurance?" Related issues have been widely concerned by the public recently.
Yang Qi, deputy director and spokesperson of Chancheng Branch of Foshan Medical Insurance Bureau, said that citizens who are currently engaged in occupational exposure risks have begun to receive COVID-19 vaccine. Recently, medical insurance bureau also made it clear that all people should be vaccinated with COVID-19 vaccine free of charge. In other words, COVID-19's vaccine and vaccination costs are borne by the medical insurance fund, and the financial fund subsidizes the medical insurance fund, and individual residents do not bear the costs.
As for nucleic acid detection, Zhen Xianghua, head of the office of Chancheng Branch of Foshan Medical Insurance Bureau, said that at present, nucleic acid detection for key people who should be checked and checked is included in the scope of medical insurance settlement, including: close contacts, overseas personnel entering Guangdong, fever outpatients, newly admitted patients and accompanying personnel, staff of medical institutions, port quarantine and border inspection personnel, pension institutions, welfare homes, maternity and child institutions and other staff. These types of insured people do nucleic acid testing, and individuals do not need to bear the cost.
If individuals or enterprises do nucleic acid testing, they can go to designated hospitals within their jurisdiction. In March this year, the cost of nucleic acid testing in public hospitals in COVID-19 was adjusted from 60 yuan to 50 yuan. In addition, the cost of kit will be around 10 yuan, which means it will be reduced to 60 yuan at one time.
The implementation of a number of new regulations has made it more "flat" to see a doctor and buy medicine.
Since March this year, the new medical insurance drug list has been officially launched nationwide, including more than 2,800 kinds of drugs, which means that it is cheaper for citizens to see a doctor and buy drugs.
"According to the actual situation, our provincial medical insurance bureau has increased some drugs on the basis of the national medical insurance drug list, reaching more than 3 100." Yang Qi said that this catalogue adjustment has added many new drugs, such as those related to medical treatment in COVID-19, and medical treatment in COVID-19 is more secure. There are also anti-cancer drugs, including 17 kinds of anti-cancer drugs such as Baizean and Baiyueze, which can save patients 3 billion yuan, with an average price reduction of 14.95%.
The National Catalogue of Drugs for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2020) contains more than 50 kinds of anticancer drugs, and patients with malignant tumors are expected to use new and good anticancer drugs with more favorable prices.
In addition, since this year, the "Foshan Basic Medical Insurance Outpatient Management Measures for Specific Diseases (Provisional)" has been implemented. The number of chronic diseases in Mentougou has been expanded from 42 to 6 1 species, and outpatient rehabilitation treatment, bronchial asthma and pulmonary hypertension after discharge in COVID-19 have been added.
The second hospital of the city launched the online settlement and payment function for patients with chronic diseases.
"At present, the insured can sign a family doctor for 95% medical insurance reimbursement." Yang Qi said that from March this year, insured persons who simply enjoy special treatment for hypertension and diabetes can choose medical institutions recognized by the health department to undertake family doctor signing services. If the insured chooses a medical institution contracted by a family doctor for medical treatment, the reimbursement rate can be increased to 95%, which is higher than that of other designated medical institutions contracted by non-family doctors 10%-20%.
take for example
When tertiary medical institutions were selected as designated points, 75% of the expenses could be reimbursed. Now choose a medical institution contracted by a family doctor, and the reimbursement rate can be increased to 95% and 20%. ※.
At the beginning, secondary medical institutions were selected as designated points, and 80% of them could be reimbursed. Now, if you choose a medical institution contracted by a family doctor, the reimbursement rate can be increased to 95%, and the reimbursement rate can be increased by 15%. ※.
First-class medical institutions were selected as fixed points, and 85% of them could be reimbursed. Now choose a medical institution contracted by a family doctor, and the reimbursement rate can be increased to 95%, and the reimbursement rate can be increased to 10%. ※.
Tip for you: If the insured person has chosen a family doctor to sign up for service, but is referred to an unsigned medical institution for treatment of special diseases, the reimbursement rate of medical expenses will be reduced to 40%.
Babies can receive these maternity "allowances"
At present, the maternity insurance benefits implemented in Foshan include maternity medical expenses and maternity allowance.
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Maternity medical expenses
(1) Medical expenses for delivery. Refers to the medical expenses incurred by female employees during pregnancy and childbirth, including prenatal examination expenses, termination of pregnancy expenses and medical expenses during hospitalization.
(2) Family planning medical expenses. Including medical expenses incurred by workers in placing or taking out intrauterine devices, tubal ligation and recanalization, induced abortion and induction of labour.
(three) other project expenses as stipulated by laws, regulations and rules. The maternity medical expenses enjoyed by the unemployed spouse of employees shall be implemented in accordance with the subsidy standard of maternity medical expenses of the basic medical insurance for residents in this Municipality.
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maternity benefits
Including maternity leave and family planning leave.
According to Article 22 of the Measures for the Implementation of Maternity Insurance for Employees in Foshan City, "During the period when employees enjoy maternity leave or family planning operation leave according to regulations, their maternity allowance shall be paid by the employer on a monthly basis according to the original salary standard of employees, and then the social insurance agency shall allocate it to the employer according to regulations.
Calculation of maternity allowance
Based on the average monthly salary of employees in the previous year of the employer where the employees gave birth or carried out family planning surgery, divide it by 30 and multiply it by the prescribed number of vacation days.
Suppose an enterprise has employees 100, and the total monthly declared salary is 400,000 yuan, then the standard of maternity allowance paid by social security to the enterprise is:
Average monthly salary of employees: 400,000 yuan/person = 4,000 yuan/person.
Total natural childbirth allowance: 4000 yuan ÷30 days ×98 days ≈ 13067 yuan.
Total maternity allowance for caesarean section: 4000 yuan /30 days × 128 days ≈ 17067 yuan.
Incentive leave is not included in the number of days of maternity leave allowance. Therefore, if the average monthly salary base of employees in the previous year is high enough, they can get an allowance of more than 10,000 yuan.
Popular question and answer
ask
Why do I have to show my ID card when I brush my medical insurance card at the pharmacy now?
The National Medical Insurance Bureau recently issued new regulations, and the "two-fixed" institutions must check the valid identity certificates of the insured to ensure that the person's certificate is consistent. Under special circumstances, if you purchase drugs for others, you should show your valid certificates and those of the person being purchased. Prevent stealing other people's medical insurance cards to buy medicines.
The "two fixed" institutions are designated medical institutions and designated retail pharmacies.
answer
ask
Relatives bought Ping An Buddha medical insurance, and the tumor is being treated in the hospital. What expenses can be reimbursed?
The minimum deductible of medical insurance for Ping An Buddha is10.5 million yuan.
If you are insured in Foshan, the maximum amount of basic medical insurance is 300,000 yuan. First, basic medical insurance can be reimbursed, and then there is 400,000 critical illness insurance. After the reimbursement of basic medical insurance and critical illness insurance, the compliance expenses borne by other individuals will be included in the medical insurance claims of Ping An Buddha.
For details, please consult Foshan Ping An Company.
answer
ask
How to supervise the illegal use of medical insurance funds?
The Regulations on the Supervision and Administration of the Use of Medical Security Funds will be officially implemented in May this year. Chancheng Branch of Foshan Medical Insurance Bureau will adhere to the full coverage of supervision and inspection, focusing on special rectification of "three fakes" and "three fakes" such as "fake patients", "fake diseases" and "fake bills". In the first half of 200212002, "clearing obstacles" will be organized to promote intelligent supervision and improve the level of supervision.