Since 2022, great changes have taken place in employee medical insurance, and the detailed rules for the implementation of the outpatient economic security mechanism of basic medical insurance for employees in various places have also been implemented one after another. Anhui will also face the new adjustment of employees' medical insurance, the reimbursement amount of medical insurance personal accounts has changed, and there are new regulations for outpatient reimbursement.
According to the "Detailed Rules for Establishing and Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients" recently issued by Anhui, the economic security mechanism for employees' medical insurance outpatients will be fully implemented before June 165438+ 10, 2022. At that time, the outpatient treatment of medical insurance for employees and the method of calculating and distributing personal accounts will be different from the past.
First, the change of personal account recording method of medical insurance.
According to the new regulations, all medical insurance expenses paid by employees are included in personal accounts, all medical insurance expenses paid by units are included in overall accounts, and some expenses are no longer included in employees' personal medical insurance accounts.
The personal medical insurance account for retirees is calculated as 2% of the basic pension base of the whole province in 2022, and the monthly quota is finally determined as 70 yuan.
In the past, taking Hefei as an example, employees under the age of 45 were included in the personal account of medical insurance according to 3% of their monthly payment base; Employees who have reached the age of 45 are included in the monthly payment base; Retired (retired) personnel are included in 4% of the average wage of local employees.
That is to say, for employees in Hefei, the proportion of individual medical insurance accounts is reduced from 3% to 2% for those under 45 years old, and from 2% for those over 45 years old. For retirees, the proportion of individual medical insurance accounts is reduced from 4% of the average salary to a fixed amount in 70 yuan.
Suppose a retiree in Hefei, according to the local average wage of 6,000 yuan, then according to the previous standard, the monthly medical insurance rebate can reach 6,000 * 4% = 240 yuan, and then the monthly medical insurance rebate will be adjusted to 70 yuan, that is, the monthly medical insurance rebate of this retiree will be reduced from 240 yuan to 70 yuan, which is 170 yuan.
Second, the change of outpatient reimbursement treatment
According to the new regulations, people who participate in employee medical insurance can enjoy outpatient reimbursement, unlike before, which can only be paid through the money in the personal account of medical insurance.
The threshold for outpatient reimbursement is 800 yuan, with a maximum reimbursement of 2,000 yuan in a natural year.
In terms of reimbursement ratio, the reimbursement ratio of tertiary designated medical institutions is 50%, that of secondary designated medical institutions is 55%, and that of tertiary designated medical institutions is 60%. The reimbursement rate of retirees is 5% higher than that of on-the-job employees, that is to say, the reimbursement rate of retirees in first-class designated medical institutions is 55%, that of second-class designated medical institutions is 60%, and that of third-class designated medical institutions is 65%.
Finally, with the implementation of the new regulations for employees, the scope of use of medical insurance personal accounts is also expanding, which can be used not only by myself, but also by spouses, parents and children, so that the expenses incurred in designated medical institutions and the expenses for purchasing medicines in designated pharmacies can be paid by personal accounts. In addition, the money in the personal account of medical insurance can buy medical insurance for urban and rural residents for parents.