1. Why should the personal account transfer standard be adjusted?
The adjustment of personal account charging methods and policies is to implement the requirements of improving personal account charging methods in the Guiding Opinions of the General Office of the State Council on Establishing and Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients. The basic medical insurance premiums paid by employees are all included in the overall fund and are no longer included in personal accounts.
By adjusting the overall fund and individual account structure, great economic benefits can be achieved from the original individual accumulation to mutual assistance. On the basis of not increasing the proportion of units and individuals, it is more conducive to the sustainable development of the medical insurance system and further improve the efficiency of fund use and the level of treatment guarantee.
1. Improve the outpatient service guarantee standard. Starting from June 65438+1 October1in 2023, the maximum payment limit for employees' medical insurance clinics will no longer be set, and the proportion of reimbursement below 20,000 yuan will remain unchanged; Employees with more than 20,000 yuan will be reimbursed 60%, and retirees will be reimbursed 80% (including unified supplementary medical insurance for retirees). There is no upper limit.
2. Further reduce the high medical burden of the insured. Since 2022, the threshold for serious illness insurance for urban employees has been lowered from 39,525 yuan to 30,404 yuan.
2. What date does the personal account fund transfer every month?
From September 1 day, 2022, before the 5th of each month, the medical insurance agency will complete the transfer of funds to the personal accounts of employees and retirees according to the collection of medical insurance premiums.
First, the scope of residents' medical insurance
1, the urban residents' basic medical insurance fund is mainly used to pay the medical expenses of insured residents for hospitalization and outpatient serious illness and outpatient rescue, and the scope and standard of payment are implemented according to the list of drugs, diagnosis and treatment items and medical service facilities of urban residents' basic medical insurance.
2, Qifubiaozhun (also known as the threshold fee) is the same as the basic medical insurance for urban workers, that is, three-level 980 yuan, two-level 720 yuan and one-level 540 yuan.
3. Medical treatment management: The residents insured by the basic medical insurance for urban residents shall implement the system of fixed-point first visit and two-way referral. The designated medical institutions for the first visit are community health service centers, specialized hospitals, hospital-store cooperation and secondary and below medical institutions, and some tertiary comprehensive medical institutions are transferred to specialized medical institutions. When insured residents seek medical treatment, they should first seek medical treatment in the first-visit medical institution. If referral treatment is really necessary due to illness, the first-visit medical institution shall issue a referral certificate before being transferred to the designated referral hospital for hospitalization.
Second, how to charge for the personal account of the medical insurance card?
Part of the money paid by the unit into the personal account medical insurance card according to the age of employees is used up and recharged; It is also suitable for individuals. We use up the money in the medical insurance card every July, including the money in the medical insurance card. You don't need to charge yourself. The medical insurance center automatically recharges you regularly, only according to the situation included in your personal account: all the medical insurance fees paid by individuals enter your personal account.
Legal basis:
Notice of Beijing Municipal Health Insurance Bureau on Adjusting Relevant Policies of Basic Medical Insurance for Urban Workers in this Municipality
First, from September 1 2022, all the basic medical insurance premiums paid by employees will be included in individual accounts, and the inclusion standard is 2% of the base of my insurance payment, and all the basic medical insurance premiums paid by employers will be included in the overall fund; Retirees' personal accounts continue to be transferred out of the overall fund according to the quota. The specific transfer criteria are: for those under 70 years old, the transfer criteria are 100 yuan/month, and for those over 70 years old (inclusive), the transfer criteria are 1 10 yuan/month.
II. Since September 1 day, 2022, the personal account funds will be used for special purposes, and the insured may not withdraw them. Insured persons use personal accounts in a targeted manner in accordance with the Supplementary Notice of Beijing Medical Insurance Bureau on the Use Scope of Personal Accounts for Basic Medical Insurance for Urban Employees (J.H.F. [2021] No.22).
The personal account funds transferred before September 2022 1 can still be withdrawn. People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.