From July 1 day, 2022, the city added 15 oral medical services such as tooth desensitization treatment, fluoride caries prevention treatment and scaling treatment into the scope of medical insurance payment. The specific projects are as follows:
The second favorable policy: the establishment of outpatient economic security mechanism, employees can reimburse dental care.
Since July 1 2022, the city has implemented the overall system of medical insurance outpatient service for employees, and the medical expenses incurred in designated medical institutions are included in the scope of medical insurance reimbursement according to regulations, and enjoy the following benefits:
In a natural year, the threshold for outpatient expenses (including oral diseases) for employees is 800 yuan;
The proportion of payment by first-class designated medical institutions is 60%, that by second-class designated medical institutions is 55%, and that by third-class designated medical institutions is 50%. The contribution rate of retired employees is 5 percentage points higher than that of on-the-job employees; The annual payment limit for employees is 2000 yuan.
The third policy is favorable: the cost of dental implants is expected to decline at the end of the year. At present, the country has included the implanted system into the procurement plan with quantity.
From mid-August to early September, the Medical Insurance Bureau of our city has completed the investigation and registration of dental implant services and medical service prices in all medical institutions in the city (including public/non-public, medical insurance designated/non-medical insurance designated), and found out the current situation of dental implant fees in our city; On June+10, 5438, the Municipal Medical Insurance Bureau * * * organized 27 medical institutions providing dental implant services in the city to fill in the centralized procurement requirements of dental implant systems of provincial alliances. In the next step, we will continue to further promote the special treatment of dental implant prices, and the burden of dental implant expenses for the masses is expected to be effectively reduced before the end of the year.
trouble shooting
① Can all dental treatments be reimbursed?
At present, according to the relevant regulations of the medical service items of the Provincial Medical Insurance Bureau, only the medical treatment items within the scope of medical insurance payment can be reimbursed within the scope of outpatient co-ordination, and other items not included in the scope of medical insurance payment (such as dental implants and deformity correction) have not been reimbursed in the outpatient department.
(2) Are all stomatological hospitals eligible for outpatient reimbursement?
Our city's outpatient co-ordination reimbursement is limited to medical institutions designated by medical insurance. At present, the outpatient oral diagnosis and treatment of employees in designated medical institutions (including township hospitals and community health service centers) above the municipal level can be reimbursed as a whole according to the outpatient policy of employee medical insurance.
③ What are the reimbursement policies for dental care for urban and rural residents?
At present, the medical expenses incurred by urban and rural residents in designated medical institutions at or below the county (district) level within the scope of medical insurance payment can be reimbursed according to the reimbursement policy for general outpatient clinics of urban and rural residents (there is no deductible line, the reimbursement ratio is 55%, and the total annual reimbursement does not exceed 200 yuan); Medical expenses within the scope of medical insurance payment generated by secondary and above designated medical institutions can be reimbursed according to the reimbursement policy for large outpatient clinics for urban and rural residents (the deductible line is 2,000 yuan, accounting for 35%, and the total annual reimbursement does not exceed 4,000 yuan).
(4) See if the oral cavity (or teeth) can be reimbursed only if it exceeds the minimum payment at one time.
No need. Every time you go to see a dentist or any disease, the amount of outpatient service is cumulative, not limited to the same medical institution. The part above the cumulative deductible can enjoy the outpatient reimbursement policy.
⑤ After the medical treatment items within the scope of medical insurance payment are reimbursed within the scope of outpatient co-ordination, can the out-of-pocket part be covered by the employee's spouse, parents and children's personal accounts?
Yes, outpatient dentistry (or dental care) can be paid by using the balance in the personal accounts of spouses, parents and children according to the employee medical insurance policy.
Legal basis:
People's Republic of China (PRC) China Physician Law
Twenty-fifth doctors should explain the patient's condition, medical measures and other matters that need to be informed in the diagnosis and treatment activities. If surgery, special examination and special treatment are needed, the doctor shall explain the medical risks and alternative medical schemes to the patients in time and obtain their explicit consent; If it is impossible or inappropriate to explain it to the patient, it shall explain it to the patient's close relatives and obtain their clear consent.
Article 52 The State establishes and improves the medical risk sharing mechanism. Medical institutions should participate in medical liability insurance or establish and participate in medical risk funds. Encourage patients to participate in medical accident insurance.
Regulations on the administration of medical institutions
Fourteenth medical institutions to practice, must be registered and obtain the "medical institution practice license"; In accordance with the provisions of the administrative department of health of the State Council, the clinic can practice after filing with the administrative department of health of the local people's government at the county level.
Article 46. Whoever, in violation of the provisions of Article 26 of these regulations, conducts diagnosis and treatment activities beyond the scope of registration or filing shall be given a warning by the administrative department of health of the people's government at or above the county level, ordered to make corrections, and his illegal income shall be confiscated, and he may be fined between 654.38 million yuan and 654.38 million yuan according to the circumstances; If the circumstances are serious, its Practice License of Medical Institution shall be revoked or it shall be ordered to stop practicing.
Article 47 Whoever, in violation of the provisions of Article 27 of these regulations, uses non-health technicians to engage in medical and health technical work shall be ordered by the health administrative department of the people's government at or above the county level to make corrections within a time limit and may be fined between 654.38 million yuan and 654.38 million yuan; If the circumstances are serious, its Practice License of Medical Institution shall be revoked or it shall be ordered to stop practicing.