Small medicine money refers to the funds returned from the personal account of employee medical insurance.

Employee medical insurance is divided into two parts. The unit pays 8% of the salary base and goes into the overall account. The employee personally bears about 2% of the base for medical insurance. This part of the funds is fully returned to the employee's personal medical insurance card for consumption in employees' hospital outpatient clinics and pharmacies.

When you leave the company and pay for employee medical insurance yourself, you need to pay 10% of the base for medical insurance, of which 2% of the base for medical insurance will still be returned in full to your medical insurance card for your medical expenses.

Payments are lower, benefits are higher. One of the highlights of this policy adjustment is the reduction of individual accounts for employee medical insurance.

In accordance with the personal account transfer methods and time arrangements stipulated in provincial government documents, starting from January 1, 2023, the personal account inclusion standard for active employees will be based on 2% of the individual’s insurance payment base; the personal account of retirees will be based on the individual account in 2022.

The account transfer scale is based on a monthly fixed amount.

Starting from January 1, 2024, the amount transferred into the personal accounts of retirees will be uniformly adjusted to 2.5% of the average level of basic pensions in the year when the reform was implemented in the coordinating region.

After adjusting the overall pooling fund and individual account structures, the increased pooling fund is mainly used to improve the outpatient benefits of insured persons.

While reducing personal accounts, the treatment levels for outpatient clinics and special services have been increased.

All outpatient expenses for insured persons within the scope of the prescribed policy will be included in the payment scope of the general outpatient pooling fund. The minimum outpatient pooling payment standard will be reduced from 1,500 yuan to 700 yuan (halved for retirees), and the fund payment limit within a pooling year will be 1,200 yuan.

The medical expenses within the scope of the policy will be increased to 7,000 yuan. For insured persons seeking outpatient treatment in primary, secondary and tertiary medical institutions, the reimbursement ratio will be increased from 70% to 75%, 60% to 65%, and 50% to 60% respectively.

, retirees will increase by another 10 percentage points on this basis.

Implementing the types of special diseases uniformly determined by the Provincial Medical Insurance Bureau, the types of special diseases in Xuzhou City will be increased from 10 types in 5 categories to 20 types in 8 categories. At the same time, the method of paying according to the limit of disease types will be cancelled. The annual payment for special diseases and hospitalization fees will be cancelled.

Payment limits will be set, and reimbursement channels for drug purchases in A-level pharmacies will be opened up for special patients.

The financing standard for employee critical illness insurance is 140 yuan per person per year (the unit and the individual bear 70 yuan respectively, and flexible employment and retirees are paid by individuals), and the unit no longer bears the obligation to pay for retirees.

After the adjustment, the personal contributions of active employees will be reduced by 66 yuan per year, and the annual contributions of enterprises will be reduced by 30 yuan.

In terms of benefits, the annual minimum payment standard has been lowered from 19,000 yuan to 16,000 yuan, and the reimbursement ratio is 10 percentage points higher than the original employee supplementary medical insurance and resident critical illness insurance.

In accordance with the requirements of the national and provincial benefit lists, the current four levels of Xuzhou’s employee medical insurance, including basic medical insurance, large medical expense subsidies, supplementary medical insurance, and medical assistance, are merged into three levels: basic medical insurance, critical illness insurance, and medical assistance.

level.

In accordance with the requirements of the national and provincial benefit lists, the meaning of the concept of outpatient and inpatient payment limits in Xuzhou has been adjusted from "the overall fund payment limit" to "the medical expense limit within the policy scope."

Within the same coordinating year, the original maximum payment limit of the coordinating fund of 280,000 yuan was adjusted to the maximum payment limit of 400,000 yuan for medical expenses (including outpatient medical treatment) within the scope of the policy.

Personal account family financial personal account funds are mainly used to pay out-of-pocket expenses incurred by insured persons in designated medical institutions within the scope of the policy. They can be used to pay for medical treatment in designated medical institutions by the insured persons themselves and their spouses, parents, and children.

Medical expenses incurred by individuals, as well as expenses incurred by individuals when purchasing medicines, medical equipment, and medical consumables at designated retail pharmacies.

Personal account funds can be used for insured persons to make personal payments for employee critical illness insurance, long-term care insurance, etc. and to purchase qualified commercial health insurance. They can also be used to pay deputy chief physicians and chief physicians (including clinical medical experts who enjoy special government subsidies).

The excess of outpatient diagnosis and treatment fees over ordinary outpatient diagnosis and treatment fees, and the excess of the outpatient TCM dialectical treatment fees of the deputy chief physician and chief physician (including clinical medical experts who enjoy special government subsidies) over the general outpatient TCM dialectical treatment fees; My family doctor signed the contract

The personal portion of the service fee is paid out of pocket.

Based on the medical needs of family members and on a voluntary basis, the main account holder applies to establish a family financial relationship through channels such as Jiangsu Medical Insurance Cloud, the coordinated regional medical insurance public service platform, and the service window of the medical insurance agency.

Expenses incurred by family members that are within the scope of the use of personal account funds should be paid with their own personal account funds first. The part with insufficient funds in the personal account, and if the person does not have a personal account, should be paid through family finance.

The main account and family members can only join one family financial relationship. If you need to change the family financial relationship, you can join a new family financial relationship after exiting.

To improve the accessibility of medical services, the relevant person in charge of the Xuzhou Municipal Medical Insurance Bureau said that this time the relevant policies for employee medical insurance will be adjusted to further improve the outpatient financial security mechanism. First, the country and the province have put forward clear requirements for outpatient financial security measures.

.

The second is an inevitable measure to implement the benefit list system of superior departments.