According to the provisions of Guobanfa [2021] No. 14 document, in order to further improve the basic medical insurance system for employees with mutual assistance, economy and responsibility, better solve the problem of outpatient protection for employees insured by employee medical insurance, and effectively reduce their medical expenses

burden, which mainly involves three aspects: first, to promote the shift of employee medical insurance outpatient protection from personal security to social economic security; second, to improve the allocation and service capabilities of grassroots medical resources and reduce the cost of medical treatment for the masses; third, to

Measures have been taken to improve the security system and improve the health security level of the elderly.

In addition, multiple measures to improve the security system and improve the health security level of the elderly involve three aspects: First, improve outpatient security.

The second is special treatment for the special needs of the elderly.

The third is to propose a new mechanism to expand the scope of use of personal accounts and improve family finance.

So, in the 2023 employee medical insurance reform in Jiangsu Province, which benefits will change, and will the reimbursement ratio increase? According to public reports, the General Office of the Jiangsu Provincial Government issued the "About Establishing and Improving Employee Basic Medical Insurance Clinics*" on December 27, 2021

"Opinions on the Implementation of the Financial Security Mechanism", according to Su Zhengbanfa [2021] No. 108, the reform of the employee outpatient financial security system mainly includes four aspects: First, establish and improve the general employee medical insurance

The outpatient fee co-ordination guarantee mechanism enhances the outpatient financial guarantee function.

Among them, the implementation opinions stipulate that ordinary outpatient expenses that are within the scope of the basic medical insurance policy and exceed the minimum payment standard will be included in the payment scope of the outpatient overall fund.

Taking Suzhou City as an example, according to the provisions of the "Implementation Measures for Improving the Financial Security Mechanism for Outpatient Basic Medical Insurance for Employees" issued by Suzhou City in September 2022, there are three aspects of adjustment and optimization: First,

Increase the maximum payment limit for general outpatient services.

The maximum annual general outpatient payment limit for insured employees will be increased from the current 4,000 yuan for in-service and 4,800 yuan for retired employees to 13,000 yuan.

The minimum payment standard remains at the current level, including 600 yuan for active employees and 400 yuan for retired employees. At the same time, a dynamic adjustment mechanism for the minimum payment standard and maximum payment limit has been established and improved.

The second is to adjust the payment scope of the basic medical insurance pooling fund.

Starting from January 1, 2023, the general outpatient expenses incurred by insured employees that comply with the provisions of the medical insurance policy, above the minimum payment standard and below the maximum payment limit, will be paid by the basic medical insurance co-ordinating fund in accordance with the prescribed proportion.

Among them, the overall fund payment proportions for active employees (including flexible employment) seeking medical treatment in qualified primary and primary medical institutions, secondary medical institutions, and tertiary medical institutions are 80%, 75%, and 60% respectively.

On the basis of retired employees and active employees, the rate will be increased by 10 percentage points respectively.

Third, after the reform, insured employees can enjoy corresponding outpatient benefits in medical insurance designated medical institutions in accordance with corresponding regulations.

Through the province's unified prescription circulation platform, when insured employees purchase drugs at qualified designated retail pharmacies, they can be paid by the basic medical insurance coordinating fund according to regulations, and the payment ratio of the coordinating fund can be consistent with that of designated medical institutions that dispense prescriptions.

If designated pharmacies do not yet support prescription circulation, the payment ratio will be based on the ratio of third-level medical institutions.

Second, standardize employee medical insurance outpatient chronic disease and special disease coverage.

These include establishing a unified outpatient chronic disease system across the province and gradually unifying the scope of chronic and special disease outpatient services across the province.

Taking Suzhou City as an example, according to the provisions of the "Implementation Measures for Improving the Financial Security Mechanism for Outpatient Clinics of Employee Basic Medical Insurance" issued by Suzhou City in September 2022, on the premise of ensuring that the overall comprehensive security level of outpatient clinics for insured employees does not decrease.

Next, we will adjust and optimize outpatient special disease and chronic disease protection policies.

Among them, outpatient special diseases are implemented in accordance with the "Notice of the Jiangsu Provincial Medical Security Bureau on Unifying Basic Medical Insurance Outpatient Special Disease Protection Policies"; outpatient chronic diseases are unified into the outpatient financial security mechanism to achieve municipal-level coordination under basic medical insurance.

Fairness, standardization and uniformity of employee medical insurance outpatient benefits across the city.

Third, improve the accounting method for personal accounts.

This includes that starting from January 1, 2023, the basic medical insurance premiums paid by the individual will be included in the personal account of active employees every month. The inclusion standard is 2% of the individual’s insured payment base, and all basic medical insurance premiums paid by the unit will be included in the calculation.

Co-ordination Fund; Starting from January 1, 2023, retirees’ personal accounts will be transferred in fixed monthly amounts according to the 2022 personal account allocation scale. From January 1, 2024, the transfer amount to retirees’ personal accounts will be uniformly adjusted to the overall planning area according to

Opinion: 2.5% of the average basic pension level in the year when the reform is implemented.