from December 1, 222, the general outpatient expenses of the first-class insured in Shenzhen employee medical insurance can be reimbursed by the medical insurance pooling fund! On November 15th, the city will implement the economic security reform of medical insurance outpatient service for employees, and more than 5% of the insured employees in the first grade of basic medical insurance in our city and the medical insurance pooling fund for general outpatient expenses can be reimbursed. It is understood that the reform of the economic security system for workers' outpatient service is a major reform designed by the top level at the national level and issued by the province to unify the standards and requirements. Before the end of this year, all parts of the province will implement it uniformly. According to the requirements of the state and the province, the people who are included in the reform in our city are mainly the employees who participate in the first grade of basic medical insurance in our city, including on-the-job employees, retired employees and flexible employees.

"minor illness to the community" grassroots medical treatment offers greater benefits. Medical insurance funds are divided into pooling funds and personal accounts. Pooling funds can be understood as money used by everyone, and personal accounts are mainly for their own use. Previously, the insured employees of the first-class basic medical insurance saw the general outpatient service in the hospital, mainly brushing the personal account of medical insurance. After December 1st, the insured employees of the first-class basic medical insurance can also enjoy the reimbursement from the medical insurance pooling fund according to the regulations when they see the general outpatient service in the hospital. The reimbursement ratio and limit are related to the level of the hospital where they go to see a doctor. The higher the reimbursement ratio and limit, the more they go to the grassroots level, which will further reduce the burden of outpatient medical expenses of the insured. In terms of reimbursement ratio, the medical insurance pooling funds of first-class and below medical institutions, second-class hospitals and third-class hospitals reimbursed 75%, 65% and 55% of Class A drugs and diagnosis and treatment projects respectively, and 7%, 6% and 5% of Class B drugs respectively, and the reimbursement ratio of retirees increased by 5%; No deductible line is set. The part of the general outpatient expenses reimbursed by the overall fund can be paid by the insured's personal account. In terms of reimbursement limit, the maximum reimbursement limit of the annual medical insurance co-ordination fund per person in the general outpatient department of the first-class employees with basic medical insurance does not exceed 5% of the average annual salary of employees in this city in the previous year (the current standard is about 6972 yuan). Among them, the maximum reimbursement limit of the annual medical insurance co-ordination fund per person in the general outpatient department of hospitals and specialized hospitals above the second level does not exceed 2.5% of the average annual salary of employees in this city in the previous year (the current standard is about 3486 yuan), so as to encourage the insured to "go to the community for minor illness". With the annual average salary of employees changing year by year, the maximum reimbursement limit will be dynamically adjusted. For example, before December 1st, Xiao Zhang, a first-class employee insured by basic medical insurance, went to a tertiary hospital for outpatient service, and 2 yuan, who took blood tests, all swiped his personal account with a medical insurance card. From December 1st, the same 2 yuan will be reimbursed by the medical insurance pooling fund to 11 yuan, and the remaining 9 yuan will be paid by the personal account of the medical insurance card. If Xiao Zhang goes to the selected social rehabilitation center for medical treatment, the reimbursement will be more favorable. The overall fund can reimburse 15 yuan, and the personal account only needs to pay 5 yuan, so the expenses paid by Xiao Zhang for outpatient treatment will be greatly reduced.

in terms of general outpatient service, according to the unified requirements of our province, the insured need to choose a designated medical institution for medical treatment in order to enjoy the overall treatment of general outpatient service. In principle, each person chooses a medical institution. In combination with the actual situation, the number of selected medical institutions has been increased in our city. The insured workers in the first grade of basic medical insurance can simultaneously select a primary medical institution (including a community health institution or other medical institutions below the first grade), a hospital above the second grade and a specialized hospital in this city as designated medical institutions for general outpatient care. Among them, if one community health institution is selected, the superior hospital to which this community health institution belongs and other community health institutions belonging to this hospital are automatically included in the selected scope, which is equivalent to "choose one and get n". If the first-class employees of basic medical insurance want to select primary medical institutions, individuals can do it through online channels such as official website Personal Online Service System of the Municipal Medical Insurance Bureau, Shenzhen Medical Insurance WeChat WeChat official account, and I Shenzhen APP, or they can do it on the spot in primary medical institutions. The online processing channel will be opened on November 2, and the insured can select primary medical institutions in advance, and they can enjoy the treatment directly after December 1. If it is not selected in advance, don't worry. The online selection channel is open 24 hours a day and can be handled at any time, and it will take effect immediately after the first selection, which will not affect the reimbursement for medical treatment. If you want to change the previously selected designated medical institutions at the grass-roots level, you only need to do a change operation. Our city allows flexible changes. Compared with the practice of selecting them once a year in other places in the province, our city's regulations are more convenient for the insured. One thing to remind you is that changing the selected designated medical institutions at the grass-roots level will take effect on the first day of the next month, and you will still enjoy treatment at the original designated medical institutions at the grass-roots level that month. If the insured person of the first-class employee of basic medical insurance wants to choose a second-class or above medical institution or a general outpatient department of a specialized hospital for medical treatment, the individual does not need to operate, and the selection or change operation is automatically completed by the hospital information system when registering, so as to realize "no-feeling second operation" and not affect the normal medical treatment experience of the insured person. For example, Xiao Zhang, the first-class employee insured by basic medical insurance, selected Meijing Community Health Service Center in Futian District as the designated medical institution at the grass-roots level. According to the convenience regulation of "choose one and get n", Xiao Zhang can see the outpatient service at the Second People's Hospital in Futian District, the superior hospital of this social health center, or at all 13 social health institutions under this hospital, and all of them can enjoy the overall treatment of general outpatient service. If Xiao Zhang wants to go to Shenzhen People's Hospital, Shenzhen Maternal and Child Health Hospital and other big hospitals or specialized hospitals for outpatient service, he can go directly to see a doctor and enjoy the overall treatment of general outpatient service according to regulations after making an appointment and registration.

The activated personal account can be used to buy cotton swabs, masks, etc. Since December 1st, the activated personal account for medical insurance has been used in a wider range. On the basis of the existing activated use range, the following new uses have been added: First, medical devices and medical consumables such as cotton swabs, masks, blood glucose test strips and thermometers can be purchased in designated retail pharmacies; Second, it can pay individual contributions for spouses, parents and children to participate in the basic medical insurance for residents; Third, you can also pay yourself medical insurance premiums that you need to continue to pay after retirement due to insufficient years of participation. At present, it has been realized that personal accounts are used by family members who are insured in our city. Next, with the advancement of medical insurance information construction, it will be gradually extended to family members who are insured in different places.

adjustment of personal account inclusion standard The original treatment of 52 outpatients with specific diseases remains unchanged. According to the unified arrangements of the state and Guangdong Province, the inclusion standard of medical insurance personal accounts will be implemented in the whole province from December 1, specifically: all medical insurance personal contributions of employees in the first grade of basic medical insurance will be included in personal accounts, and the unit contributions will be included in the medical insurance pooling fund, and flexible employees will be implemented with reference to the on-the-job employee standards. After retirement, retirees who stop paying fees and enjoy the first-class treatment of medical insurance will be included in the individual account by the overall fund according to the standard set by the province, and the standard for inclusion in our city is 251 yuan/month. Compared with before the reform, the total payment burden of the insured remains unchanged, and the historical accumulated amount of the personal account remains unchanged, and it is still for personal use. Only from December 1 ST, the standard for new personal accounts will be adjusted. The adjusted money goes into the medical insurance co-ordination fund used by the insured, which is mainly used for the new general outpatient co-ordination treatment. For people who are weak and sick, the general outpatient expenses can be reimbursed by the medical insurance co-ordination fund, the personal economic burden will be greatly reduced, the ability to resist disease risks will be further enhanced, and the role of medical insurance in "mutual assistance" will be fully played. In addition, the medical insurance benefits and medical treatment methods of 52 outpatient specific diseases (including chronic diseases such as hypertension and diabetes, and serious outpatient diseases such as radiotherapy and chemotherapy for malignant tumors) with heavy outpatient expenses remain unchanged, and the insured can continue to enjoy them.

The elderly are better protected by medical insurance. The proportion of reimbursement for general outpatient expenses of retired employees in the first grade has increased by 5%. The elderly have been better protected through reform. First, considering the high prevalence rate of chronic diseases among the elderly, the reimbursement rate of general outpatient expenses for retired employees with basic medical insurance increased by 5%, up to 8%. Second, retired employees with first-class basic medical insurance can use their personal accounts more flexibly according to the regulations after the reform, thus reducing their cash payment pressure. Third, the personal accounts of children who participate in employee medical insurance are eligible, and they can also be used by their parents.