6543817 October, the National Medical Insurance Bureau and other four departments jointly issued the Notice on Optimizing the Medical Insurance Policies for the Treatment Expenses of Infected Patients in novel coronavirus after the Implementation of Class B Management, which clearly stipulated the optimization of medical insurance payment policies, the implementation of the temporary medical insurance drug list, and the provision of "internet plus" medical insurance services.
The reporter learned that in the face of the new situation and new tasks of epidemic prevention and control in COVID-19, several provinces have recently introduced relevant medical insurance policies to reduce the burden of medical expenses for the masses.
To clarify the proportion of medical insurance reimbursement for infection treatment in COVID-19.
Four departments, including the National Medical Insurance Bureau, made clear the relevant medical insurance policies for outpatient and hospitalization expenses of patients in COVID-19. Among them, the insured patients in the basic medical insurance designated medical institutions and COVID-19 treatment related outpatient and emergency expenses (within the scope of medical insurance catalogue), in principle, there is no deductible and capping line, and the reimbursement ratio is not less than 70%. The specific provisions shall be determined by the local medical insurance departments in consultation with the financial department according to the operation of the medical insurance fund, and shall be implemented until March 3 1 day.
It is understood that Anhui Province issued a temporary safeguard policy at the end of June, 5438+February, 2022, which made it clear that the insured can reimburse 70% of the medical expenses for outpatient and emergency treatment of infection in COVID-19, and there is no deductible and reimbursement limit. Hospitals at all levels, even village clinics and other designated medical institutions are included in the overall settlement scope of infection clinics in COVID-19.
Ms. Tian, a citizen of Tongling City, Anhui Province, told reporters that she recently went to the hospital because of COVID-19 virus infection. The doctor prescribed 540 yuan's medicine according to her condition, and the medical insurance reimbursed her 378 yuan. "The cost of seeing a doctor is affordable, and I have confidence in the next physical recovery." Ms. Tian said.
The reporter learned from Anhui Medical Security Bureau that as of June 3, 2023, the medical insurance system for infected outpatients in COVID-19 had settled 23,800 person-times, and the medical insurance fund paid 24 1 10,000 yuan, with an average reimbursement cost of 1.0 1 yuan.
In addition, Huang Changsha, director of Jinjiang Branch of Quanzhou Medical Insurance Bureau, Fujian Province, said that in terms of outpatient service, local insured persons in Jinjiang can enjoy general outpatient treatment in primary medical institutions designated by medical insurance and see a doctor in township hospitals (community health service centers), with a reimbursement rate of 70%.
Online medical consultation is included in the scope of medical insurance payment.
With the opening of outpatient clinics and fever clinics in COVID-19 in Internet hospitals all over the country, online medical treatment has become the first choice for many patients.
In order to do a good job in the "internet plus" medical insurance service, the notice issued this time makes it clear that the first consultation service of COVID-19 infected with the Internet is allowed by the industry departments, and the mobile payment settlement service of medical insurance is provided according to regulations for COVID-19 patients who have symptoms related to COVID-19 infection and meet the "Guidelines for Home Treatment of COVID-19 Infected Persons".
Recently, Guangdong Province has introduced new measures to include the medical examination fees and medicine fees incurred by insured COVID-19 patients in the designated medical institutions of "internet plus" medical service, and the COVID-19 antigen testing fees incurred in primary medical institutions into the scope of medical insurance payment.
"In the past, only the medical expenses incurred by follow-up visits in Internet hospitals could be reimbursed through medical insurance, and now COVID-19 patients can also be reimbursed for the first visit." Li Chao, deputy director of zhujiang hospital Medical Insurance Department of Southern Medical University, said that some residents have symptoms of COVID-19 infection, but they have not been tested. Online doctors will prescribe drugs according to the specific characteristics of the disease.
Ms. Chen, a 38-year-old citizen of Guangzhou, recently went to zhujiang hospital Internet Hospital of Southern Medical University for medical treatment because of her fever and runny nose. At the time of payment, Ms. Chen used medical insurance to pay for medicines with a total cost of more than 50 yuan, and she personally only paid 18.62 yuan. "The doctors who consult online are very professional and the response is very detailed. It is very convenient to pay medical insurance. " Ms. Chen said.
In addition, Shandong Province recently issued a notice to clearly include the Internet consultation fee for symptoms related to the new crown in the scope of basic medical insurance payment, which is consistent with the offline reimbursement policy.
A variety of therapeutic drugs are temporarily included in medical insurance.
With regard to the medication guarantee for COVID-19 patients, the National Health Insurance Bureau and other four departments have made it clear that the temporary payment policy for COVID-19 drugs in the novel coronavirus infection diagnosis and treatment plan will last until March 3, 20231day. At the same time, the local medical insurance departments with insufficient drugs can temporarily expand the medical insurance drug list with reference to the list of infectious treatment drugs in COVID-19 determined by the provincial joint prevention and control institutions, combined with the operation of the medical insurance fund.
Recently, Hubei, Guangxi, Anhui and other places have temporarily included a variety of related drugs in medical insurance.
According to the relevant person in charge of Anhui Medical Insurance Bureau, Anhui recently temporarily included 36 kinds of drugs such as paracetamol for children into the basic medical insurance payment scope. One of the characteristics of the drugs included this time is the high proportion of drugs available to children. According to the functional indications of related drugs, there are 19 kinds of drugs available for children to alleviate the shortage of drugs for special groups such as children.
Guangxi Zhuang Autonomous Region temporarily included 15 drugs in medical insurance and reimbursed them as Class A drugs. Wu Shuo, director of the Medical Service Management Office of the Autonomous Region Medical Insurance Bureau, mainly used local Chinese patent medicines and ethnic medicines for fever reduction and symptomatic treatment. "Judging from the drug habits of the people in ethnic areas in Guangxi, these drugs are temporarily included in the medical insurance fund. The scope can further guarantee the current demand for therapeutic drugs. "
In Jintou Store, a pharmacy in Nanning, Guangxi, the reporter saw that the "epidemic prevention area" is located in the center of the sales area, and some citizens are buying the medicines they need.
"After receiving the documents issued by the medical insurance department, the company stepped up the organization of supply, and the store also printed and posted the relevant notice of medical insurance reimbursement at the first time." Xiao Jiaju, deputy general manager of Laobaixing Pharmacy Chain (Guangxi) Co., Ltd., said that the sales of related drugs have increased significantly recently. "Only Jintou Store has sold more than 20,000 boxes of throat-clearing and throat-moistening drugs in recent days 10."
In addition, Hubei Province recently announced that 36 kinds of drugs will be temporarily included in the scope of medical insurance reimbursement, further ensuring the supply of drugs for preventing and treating infections in COVID-19.
"We hope to reduce the burden on patients through this adjustment, so that ordinary people can have medicine to treat diseases and medical insurance reimbursement." Liu Jun, deputy director of the Medical Service Management Office of Hubei Medical Insurance Bureau, said.