just now! Latest release! Xiamen is scheduled to be officially implemented on January 1 next year, which concerns everyone in Xiamen! Expand! Turn! Send! The adjustment of medical insurance policy in Xiamen will be implemented on January 1 next year. Recently, in order to implement the unified deployment of the state and Fujian Province, the Xiamen Municipal Government issued the Detailed Rules for the Implementation of Medical Insurance for Employees in Xiamen and the Detailed Rules for the Implementation of Medical Insurance for Urban and Rural Residents in Xiamen (hereinafter referred to as the Detailed Rules). The "Rules" unified the medical insurance policies of migrant workers and employees in this city, simplified the reimbursement process of outpatient service, and enhanced the economic security function of outpatient service. The Rules will be officially implemented on January 1, 223. Medical security is directly related to the vital interests of thousands of people. The state has made systematic arrangements for the reform and development of medical insurance. Since 22, it has issued opinions on deepening the reform of the medical insurance system, establishing and improving the outpatient medical insurance mechanism for employees and the medical insurance treatment list system, and clearly requires the establishment of a unified medical insurance system framework, the adjustment of the structure of pooling funds and individual accounts, the increase of pooling funds for outpatient medical insurance, and the promotion of vertical unification of medical insurance policies and horizontal balance of treatment. Our city established the basic medical insurance system for employees in 1997, for urban residents in 27, and for urban and rural residents in 21. In order to implement the unified national and provincial arrangements, the city started the medical insurance policy reform this year. On the basis of integrating the original basic medical insurance for employees and residents, serious illness insurance and maternity insurance for employees, combined with the actual situation of our city, the Detailed Rules were revised and promulgated. According to the requirements of deepening the reform of medical insurance system in China and the province, the current medical insurance system should be further improved from the aspects of unifying the insurance policy, improving the outpatient co-ordination system and raising the maximum payment limit of serious illness insurance. The system of "one unification and one liberalization" is more perfect. The Detailed Rules unify the basic medical insurance policy for employees, and migrant employees and employees in this city pay the same fees and receive the same treatment, and liberalize the household registration restrictions for flexible employees to participate in employee medical insurance. "Unification": With the development of economy and society, the proportion of migrant workers in our city is increasing, which has played an important role in the construction of special economic zones. In order to further protect the rights and interests of migrant workers, the Detailed Rules unified the medical insurance policies of migrant workers and employees in this Municipality, adjusted the contribution rate of migrant workers' medical insurance units to be consistent with that of employees in this Municipality, and no longer distinguished the identities of migrant workers and employees in this Municipality. All employees on the job implemented the unified unit contribution rate of 7.5% and individual contribution rate of 2% in the whole province, enjoying the same medical insurance treatment. At the same time, from January to December 223, the unit contribution rate was reduced by 1 percentage point, that is, it was paid at 6.5%. "One Liberalization": In order to ensure the medical needs of flexible employees who are not registered in this Municipality, the Detailed Rules have liberalized the household registration restrictions for flexible employees to participate in employee medical insurance. As long as non-registered employees of legal working age hold valid residence permits in this Municipality, they can participate in employee medical insurance in this Municipality as flexible employees, with a contribution rate of 9.5%, enjoying the same medical insurance benefits as employees in this Municipality, effectively protecting the rights and interests of workers in new employment forms. At the same time, from January to December 223, the contribution rate was reduced by 1 percentage point, that is, it was paid at 8.5%, which reduced the burden on flexible employees. "One Adjustment, Two Norms" to Enhance the Economic Security Function of Outpatients According to the unified deployment of the state and the province, the "Detailed Rules" strengthen the economic security function of the overall fund by adjusting the individual account allocation of employees' medical insurance, standardizing the individual account and the overall policy of primary outpatient service. "One Adjustment": Like other cities in the country, the employee medical insurance in our city implements the security mode of combining social pooling with personal account, and the personal account of employee medical insurance has played an active role in promoting the transition from public labor insurance medical system to social medical insurance system. However, with the development of social economy and the improvement of people's demand, the limitations of insufficient personal account protection function and insufficient economy are gradually highlighted. This reform strictly implements the requirements of the state and the province on adjusting the method of personal accounts and enhancing the economic security function of outpatient clinics. The specific adjustments are as follows: all the individual contributions of on-the-job employees are included in personal accounts and remain unchanged, and all the unit contributions are included in the overall fund; Retirees' personal accounts are included in the standard according to the regulations, which is determined by 2.5% of the average basic pension level in the year when the reform is implemented, that is, the quota is 11 yuan per person per month. The personal account is adjusted from the original one-time pre-allocation every year to monthly allocation. "two norms": first, the health account is merged into the personal account, and all the funds in the health account are transferred into the personal account; The second is to use the basic drugs that have been included in the national medical insurance drug list in the designated public medical institutions at the grassroots level. There is no threshold for outpatient co-ordination, and it is directly reimbursed by the co-ordination fund in proportion. In 212, our city issued a health account policy, and part of the balance funds in personal accounts were transferred to health accounts, which can be used to pay for the medical expenses incurred by individuals in designated medical institutions and the mutual assistance of medical expenses among family members of the insured in this city. Under the unified deployment of the whole province, the "Detailed Rules" incorporate the function of health account into personal account, and the insured can also pay the medical expenses incurred by the insured family members in Fujian Province when they seek medical treatment and purchase medicines in designated medical institutions, and pay residents' medical insurance fees, etc. After the adjustment, the personal account has a wider range of use and stronger use efficiency. The "Detailed Rules" standardize the original "the insured enjoys the payment policy of 5 yuan's co-ordination fund for outpatient treatment in the designated medical institutions at the grass-roots level in our city", and make it clear that the insured can seek medical treatment in the designated public medical institutions at the grass-roots level and use the basic drugs included in the medical insurance catalogue without paying the outpatient Qifubiaozhun first, but can be directly reimbursed by the co-ordination fund in proportion, and there is no 5 yuan limit. After standardization, it is consistent with the province's policies, reducing the burden of medical expenses for insured people, especially patients with chronic diseases, frequently-occurring diseases and common diseases. "One simplification, one improvement and one inclination" improves the comprehensive security level. The Detailed Rules simplifies the outpatient reimbursement process, increases the maximum payment limit of serious illness insurance, and gives preferential policies to special assistance objects, further improving the comprehensive security level of the insured and securing the bottom line of people's livelihood. "One Simplification": Before the reform, the reimbursement of outpatient medical expenses was implemented in a "three-stage" mode, that is, the insured person must use up the funds in his personal account before paying the outpatient qifubiaozhun before entering the overall reimbursement. After the reform, the "Detailed Rules" simplified the outpatient co-ordination reimbursement model from "three-stage" to "two-stage", that is, the insured person can enter the co-ordination reimbursement without running out of personal account funds and reaching the threshold. Personal account funds can be used to offset outpatient qifubiaozhun and above personal out-of-pocket medical expenses. By simplifying the outpatient reimbursement process, the number of people enjoying the overall fund has been expanded, and the outpatient security level of the insured has been improved. "One Improvement": At present, the maximum payment limits of employees' and residents' serious illness insurance in a year in our city are 5, yuan and 4, yuan respectively. The Detailed Rules raise the maximum payment limits of employees' and residents' serious illness insurance to 1.1 million yuan and 5, yuan respectively. After the basic medical insurance is superimposed, the comprehensive protection level reaches 1.2 million yuan and 6, yuan respectively, which further improves the protection level of serious illness insurance, reduces the burden of medical treatment for the people, and effectively prevents the insured from getting poor due to illness and returning to poverty due to illness. "One Inclination": The Detailed Rules implements the policy of inclined payment for residents' serious illness insurance, and the minimum living guarantee object and other medical assistance objects participating in residents' medical insurance will reduce the threshold for serious illness insurance by 5%, increase the payment ratio by 5 percentage points, and cancel the maximum payment limit. Through the inclined payment policy, we will build a second line of defense for the poor people who are poor due to illness. Xiamen's revised medical assistance measures will be implemented on January 1 next year. At the end of 221, the state issued the Opinions on Improving the Medical Insurance and Assistance System for Serious and Extraordinary Diseases, making unified arrangements for improving the medical insurance and assistance system for serious and extraordinary diseases. At the beginning of August this year, Fujian Province issued the "Implementation Opinions of the General Office of the People's Government of Fujian Province on Improving the Medical Insurance and Assistance System for Serious and Extraordinary Diseases", requiring all localities to formulate specific implementation measures. In order to implement the unified deployment of the state and Fujian Province, Xiamen recently revised and promulgated the Measures for Medical Assistance in Xiamen (hereinafter referred to as the Measures). By unifying and standardizing the medical assistance system, the "Measures" highlight "precise assistance" and do a good job in medical security for serious and serious diseases of people in need. The Measures will be officially implemented on January 1, 223. The main contents can be summarized as the following five aspects: 1. Standardize the scope of five types of assistance objects. The medical assistance objects are divided into five categories: the first category, destitute dependents and orphans (including children who are actually left unattended); The second category, key special care recipients, revolutionary "five old" personnel, family planning special family members, severely disabled people; The third category, the minimum living security object; The fourth category, marginal family members with minimum living security; The fifth category, poor and seriously ill patients due to illness. At the same time, people who meet the multiple rescue status will be given assistance according to the principle of high treatment, and will not enjoy medical assistance treatment repeatedly. For medical assistance objects that are no longer included in the Measures according to national and provincial regulations, they can still be guaranteed in the following three ways: First, if they meet the conditions of assistance objects stipulated in the Measures, they can enjoy corresponding assistance treatment according to the first to fourth categories of assistance objects; Second, if they meet the conditions of the fifth category of relief objects, such as "patients suffering from poverty and serious illness due to illness", they can obtain medical assistance upon application. Third, if the basic life is really difficult, temporary assistance can be obtained through the civil affairs department. Make clear the policy of classified subsidy and participation, and give full subsidy and participation to the first and second types of relief objects; The third category of relief objects will be given a fixed subsidy according to the proportion of 9%. Reasonable adjustment of the first, second and third types of relief objects do not set the relief qifubiaozhun, and continue the current standard of our city; Qifubiaozhun for the relief of marginal family members of the fourth category of minimum living guarantee is determined by about 1% of the per capita disposable income of residents in our city in 221, which is 6 yuan; The Qifubiaozhun for the fifth category of patients suffering from poverty and serious illness due to illness is determined by about 25% of the per capita disposable income of residents in our city in 221, which is 16, yuan. Continue the current proportion of assistance in our city, and the current proportion of assistance in our city remains unchanged, among which: the proportion of assistance for the first type of assistance object is 1%; The proportion of the second and third types of relief objects is 95%; The proportion of assistance for the fourth category of assistance objects is 85%; The proportion of the fifth category of relief objects is 5%. Appropriately raise the annual relief limit. The relief limit of the first category of relief objects is still not capped, continuing the current standard of our city; The relief limit for the second to fifth categories of relief objects is uniformly adjusted to 13, yuan. Moreover, outpatient and inpatient assistance can use the annual assistance quota, and the comprehensive assistance guarantee is further strengthened, effectively helping to prevent and resolve poverty caused by illness. In addition, our city has also actively established and improved the following two supporting measures. First, by strengthening the dynamic monitoring and early warning of the high medical expenses of people in difficulty, we will improve the long-term mechanism to prevent and resolve poverty caused by illness. Second, by continuously promoting the "one-stop" real-time settlement of medical assistance expenses and other convenient services such as "first diagnosis and then payment", the convenience of handling services will be continuously improved.