Kunshan medical insurance is in line with Suzhou's overall planning.
From July 1, it is more convenient for the insured in Kunshan to go to Suzhou for medical treatment.
On June 30th, the promotion meeting of card settlement for medical treatment in different places for basic medical insurance and maternity insurance in Kunshan was held.
The meeting pointed out that Kunshan City began to implement the adjustment of basic medical insurance policies and treatment standards from July 2020 1, and promoted it year by year in an orderly manner. After 2-3 years of transition, the integration of medical insurance in our city and Suzhou city-level overall planning has been fully realized.
What is the master plan of Suzhou city?
City-level co-ordination will unify seven county-level medical insurance co-ordination areas in Suzhou into 1 city-level co-ordination areas, and unify policies, treatment standards and handling services, which will help to enhance institutional fairness, enhance the anti-risk ability of medical insurance funds, and promote the flow of people entering the city for employment and medical treatment. Since April this year, Suzhou has implemented a unified collection of medical insurance funds, and the city's medical insurance funds have one overall plan and one large account.
This year is the first year of Suzhou municipal overall planning. The medical insurance department of Kunshan City has made steady progress according to the timetable determined by the adjustment plan, and the following policy adjustments have been implemented since July 1 day. Come and have a look.
0 1, merging and simplifying the policy of Suzhou's basic medical insurance for medical treatment in different places.
After Suzhou municipal co-ordination, can residents' medical insurance be reported to the outpatient clinic outside Suzhou?
When did you get the "one card" for medical treatment in Suzhou?
In order to respond to the ardent expectations of the insured people and further optimize the medical treatment of the insured people in different places,
Kunshan took the lead in merging and simplifying the policy of medical treatment in different places in Suzhou during the transition period.
It will be included in the scope of reimbursement for outpatient expenses transferred from outside Suzhou, and the reimbursement ratio will still be implemented according to the original regulations of our city until the corresponding projects at the municipal level are adjusted.
Merge and simplify the registration and filing procedures for medical treatment abroad and in other places in Suzhou, cancel the residence certificate or the certificate for medical treatment abroad issued by the hospital with referral qualification, and the insured can bring their ID card and social security card to the medical insurance handling windows and hospitals with referral qualification, or go through the registration and filing procedures for medical treatment in other places in Suzhou through the official account of WeChat on Kunshan People's Society.
After merging and simplifying the registration procedures for medical treatment in different places in Suzhou, if the insured is hospitalized in different places in this city and Suzhou for two or more times in a medical insurance year, the minimum threshold will be lowered, of which the minimum threshold for the second time is 50%, and the minimum threshold for the third time and above is 100 yuan.
After the insured goes through the registration formalities, they will go to the designated medical institutions in Suzhou for medical treatment directly with the social security card.
In Suzhou, the registration procedures for medical treatment in different places have been handled. If the validity period of one year expires in the second half of this year, there is no need to handle it again, and the validity period will be automatically extended.
If you go to a medical treatment place in Suzhou directly without going through the registration formalities according to the regulations, it will be temporarily implemented according to the original provisions of reducing the proportion of reimbursement.
That is to say, from July 1 day, employees and residents of our city went to Suzhou for medical treatment in different places, which not only included the outpatient expenses of residents' medical insurance, but also simplified the registration and filing procedures, and no longer needed to provide proof of residence in different places or apply for proof of referral and transfer, which greatly facilitated the insured in our city to seek medical treatment independently in big cities.
02, adjust the direct settlement limit of some insured outpatient medical expenses.
Cancel the provisions in the Notice on Further Strengthening the Work of Medical Assistance to Help the Sick and Disabled Persons (Kun Ren She Fa [2017] No.21) that when the sick and disabled persons seek medical treatment in medical institutions in Gong Hui, the accumulated outpatient assistance expenses exceed 5,000 yuan, they shall go to the medical insurance agency for review and reimbursement. The above-mentioned excess part will be changed to continue to draw cards directly for real-time assistance.
Adjust the outpatient expenses of workers with Class I special diseases (malignant tumor and severe mental illness after radiotherapy and chemotherapy) in this city, and use the designated medical institutions as a whole fund to directly debit the card settlement limit, and the limit will be raised from 20,000 yuan stipulated in that year to 50,000 yuan. For outpatient medical expenses exceeding 50,000 yuan, the insured will continue to settle by credit card in designated medical institutions, and apply for reimbursement at the sporadic reimbursement window of medical insurance in this Municipality with valid vouchers, and the expenses will be borne by themselves.
The above-mentioned personnel who have gone through the registration procedures for medical treatment in different places will be adjusted simultaneously when they are directly settled in different places.
03, unified social pooling fund standards for large medical expenses.
From July 1 2020, the supplementary medical insurance fund for urban workers in our city was renamed as the social pooling fund for large medical expenses, and it was adjusted to be levied on a monthly basis, and the financing standard was 5 yuan/person/month. Before the end of June 2020, those that have been collected according to the standard of 60 yuan/person/year will not be adjusted and returned in 2020, and will be collected monthly from 200211.
Special reminder, the original supplementary medical insurance for urban workers in our city is different from the medical insurance for urban and rural residents in our city established on 20 15.
Supplementary medical insurance for serious illness of urban workers
The original supplementary medical insurance for serious illness of urban workers in our city is a supporting system established at the beginning of the reform of employee medical insurance system, which is mainly used for the subsidy that the hospitalization expenses of the employees' medical insurance insured exceed the top line paid by the basic medical insurance pooling fund during the year.
Medical insurance for serious illness of urban and rural residents
The medical insurance for urban and rural residents in our city is based on 20 15, which is what we usually call serious illness insurance. In our city, employees' medical insurance or residents' medical insurance participants enjoy the serious illness insurance of urban-rural integration, and they can enjoy the treatment of serious illness insurance when their own compliance medical expenses reach a certain standard during the year.
04, unified employee health insurance on-the-job and flexible personnel personal account distribution ratio.
On-the-job and flexible employees under the age of 45 are counted as 3% of their total wages, and those over the age of 45 are counted as 4% of their total wages.
From July 1 day, 2020, new employees and flexible employees (including those who stopped paying fees before the end of February 20 19) will be transferred to personal accounts according to the above-mentioned new proportion. For on-the-job and flexible employees who have been insured before the end of June 2020 and have been allocated annual accounts according to the old standard, the "old way of providing for the aged" will no longer be liquidated, and the new standard will be implemented from July+10/day, 20265438.
After the adjustment of the personal account transfer ratio of workers' medical insurance in Suzhou, the personal account transfer ratio of on-the-job and flexible employees in Suzhou decreased by 0.5%- 1%, but the unified personal account transfer ratio in big cities reflected the fairness of medical insurance treatment, and the basic medical insurance pooling fund was enriched and the guarantee ability was enhanced.
05. Establish local supplementary medical insurance fund.
The unit payment part of the original employee medical insurance in our city shall set up a local supplementary medical insurance fund according to the prescribed payment ratio, and establish separate accounts. The general outpatient and outpatient chronic disease expenses of the insured are paid by the original employee medical insurance pooling fund, not from the local supplementary medical insurance fund.
Among the original seven medical insurance co-ordination areas in Suzhou, some areas have set up local supplementary medical insurance funds separately, and some areas have not been set up before like our city.
The main purpose of establishing local supplementary medical insurance fund after Suzhou municipal overall planning is to unify the system and facilitate the unified and standardized accounting of medical insurance fund after Suzhou municipal overall planning.
During the transition period after separation, the employee medical insurance in our city and the local supplementary medical insurance units will be levied together, and the unit payment ratio will be implemented according to the explicit requirements of Suzhou Medical Security Bureau and other departments.
06, unified employee medical insurance hospitalization.
The hospitalization treatment of unified medical insurance for employees is consistent with the overall standard.
Municipal co-ordination of medical insurance hospitalization treatment standards for employees
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After the overall planning at the municipal level, it is inevitable that the safety level of some projects in Suzhou will rise and fall. However, the implementation of a unified medical insurance policy throughout the city reflects the fairness of treatment. Under the "market chess game", the overall security level remains balanced, while the security and economic capacity of the medical insurance fund are significantly enhanced.
The adjustment of Suzhou municipal overall medical insurance policy is a complex systematic project. In accordance with the principle of making full adjustment, implementing step by step, adjusting item by item, and actively and steadily advancing, in the later period, our city will unify the basic medical insurance drug list, diagnosis and treatment items (including special medical materials) and the scope of medical service facilities, the settlement period of employee medical insurance, the payment base of employee medical insurance, the allocation ratio of individual accounts of employee medical insurance retirees, the outpatient treatment of employee medical insurance, the coverage and personnel classification of residents' medical insurance, the outpatient treatment and hospitalization treatment of residents, and the specific project policy of outpatient medical insurance.