The new policy will be implemented in the next few years, and it will be a great success.

1. "Outpatient **** Ji" new policy when to implement?

agreed by the municipal government, "Foshan City, urban and rural residents of the basic medical insurance outpatient **** Ji protection implementation rules" "Foshan City, the basic medical insurance outpatient **** Ji protection implementation rules" in November 1, 2022 officially implemented. This is the implementation of the Guangdong Province outpatient ***ji new policy specific measures, will further optimize and enhance the city's basic health insurance general outpatient co-ordination treatment protection level.

2. "Outpatient **** Ji" new policy what optimization?

Mainly in the scope of expenditure, treatment protection, medical management, personal account management, settlement management and other aspects to be optimized and improved, see "Foshan medical insurance" WeChat public number. For example:

(1) Participants can "choose the point of medical treatment" within the city to enjoy the general outpatient medical insurance co-ordination treatment, eligible for the cross-city point of choice.

(2) the new outpatient policy of the "drug catalog" "diagnostic and treatment items catalog" "medical consumables catalog" all in accordance with the Guangdong Provincial Health Insurance Catalog, the scope of protection is further expanded! The coverage has been further expanded, and at the same time, the payment ratio of the catalog scope included in the medical insurance has been increased.

(3) Employee health insurance participants in the third-level medical institutions in the medical insurance payment ratio from 40% to 50%.

(4) Eliminate the single-day general outpatient medical insurance can only be reimbursed once the limit.

(5) The amount of monthly transfer to the personal account of retirees was increased by 34.57 yuan.

(6) Expanding the scope of use of individual account funds for employee health insurance.

3. Why is it necessary to "choose the point of care" for general outpatient treatment?

The general outpatient "choice of point of care" is a clear requirement of the state and the province, is the province's unified implementation of the policy.

(1) The state requires the promotion of the implementation of a hierarchical diagnosis and treatment system, and the gradual establishment of a hierarchical diagnosis and treatment model of "grass-roots first diagnosis, two-way referral, emergency and slow treatment, and up and down linkage", to form a pattern of "minor illnesses at the grass-roots level, major illnesses in hospitals, and rehabilitation back to the grass-roots level" of the medical treatment.

(2) The provincial government "Guangdong Provincial Office [2021] No. 56" stipulates: "In principle, the insured person selects a designated medical institution for medical treatment, generally a year must ...... be. In addition to first aid and rescue needs, participants without referral to non-selected medical institutions for outpatient treatment, the integrated fund will not pay.

4. Foshan City on the general outpatient "selected point of care" regulations?

The insured can choose no more than three designated medical institutions within the city for medical treatment, and must include a primary health care institution when choosing three, and change up to three times a year, change one for one time, and at the same time, the provisions of the "first aid, rescue do not need to 'choose the point of care'", "for the referral of the medical institutions. At the same time, it is stipulated that "emergency and rescue do not need to be 'selected for medical treatment'" and "referrals will not be counted as the number of changes", so as to maximize the convenience of medical treatment for the insured. "Choose a point of care" responds to the needs of society, the realization of the "cross-regional outpatient".

5. Is it true that there is only one point of access for each selected medical institution?

Not necessarily. Some medical institutions have more than one point of access, for example, individual community health service centers have more than 10 health service stations, and individual hospitals have more than one hospital district, so choosing them only counts as choosing one medical institution, and it is recommended that participants check with the medical institution before completing the "point of access selection.

6. Is it necessary to maintain the same "point of choice" for general outpatient services as for hospitalization and outpatient services?

This "point of choice" is only for general outpatient services. Mentor disease, hospitalization, major medical insurance current policy remains unchanged, hospitalization, major medical insurance is still "city-wide free access to all designated medical institutions", do not choose a point; Mentor disease city can choose three designated medical institutions to enjoy the treatment, and general outpatient "point of selection "The institutions can overlap, can also be different medical institutions.

7. General outpatient "point of choice" there is no deadline?

"Outpatient ****Ji" new policy in November 1, 2022 after the implementation of the general outpatient clinic must first be selected designated hospitals, in principle, the insured person only need to "complete the selection of the point before registering" to enjoy the health insurance benefits, if there is no need to see a doctor, the designated hospitals can first select the point to enjoy the health insurance benefits. If there is no need to see a doctor, the designated hospital can be selected first, or can be selected again when you see a doctor, but the participant completes the "selection of points" in advance, can effectively reduce the time of waiting in line when you see a doctor in the hospital. Especially for the elderly and children, it is recommended that they complete the "selection" in advance.

8. How do I choose a designated medical institution that suits my needs?

(1) Choose by habit. The best choice is to choose a hospital that meets your own medical habits, and "the one you always go to" is the one that you have practiced.

(2) Choose by need. According to their own condition, age, condition needs and hospital specialties to choose. For example: for children to choose a fever clinic hospital, long-term skin disease patients can choose a dermatology hospital.

(3) Choose by location. Combined with the place of residence or work to choose, choose to live or work closer to their own medical institutions.

(4) Choose by level. The designated medical institutions are divided into three levels, two levels, one level and undefined four levels, which are included in the medical insurance reimbursement ratio is different, "one level" is higher than "two levels", "two levels" is higher than "three levels". "The reimbursement rates are different.

(5) Select as required. If a participant chooses only 1 or 2 medical institutions, he or she can also enjoy the reimbursement treatment of health insurance. If all 3 medical institutions are selected, at least 1 is included as a primary health care institution.

9. What are the 6 channels of operation for "selecting points"?

(1) "Guangdong Medical Insurance" WeChat program. In the WeChat search function can be found, the small program has the function of choosing points for the family, has activated the "health insurance electronic voucher" of the participants, can be used to complete the "point selection" cell phone, see the operation of this hinge guide.

(2) Foshan Pass APP or WeChat app, available for download.

(3) "Foshan Medical Insurance" WeChat public number. Follow the "Foshan Medical Insurance" WeChat public number, and click on "General Outpatient Selection" in the "Civil Service" at the bottom.

(4) WeChat public number of the medical organization with the function of "selecting points". You can select a point by following the WeChat public number of the corresponding medical institution, and some institutions can also select other designated medical institutions.

(5) The front desk of the medical institution. Participants can bring their own and the agent's valid ID to the front desk of the designated medical institution and follow the staff's guidelines for on-site point selection.

(6) Social security window. You can go to the social security office window of the district where you are insured.

10. How can I help my family members, parents and children to choose points?

(1) Enter WeChat's "Guangdong Medical Insurance" applet, select "Outpatient Registration - Family Selection - Add Family Member", enter relevant information and add family members. "Enter the relevant information and save it to realize the binding of family members, and you can bind up to 8 family members. When you return to the interface of "Family Pick Point", you can select your family members to "Pick Point" to realize the picking point on behalf of your family members, and the operation of picking point on behalf of your family members is the same as the operation of picking point on behalf of your family members.

(2) You can select points on behalf of your family online through the public number or small program of the designated general outpatient hospitals that have online registration channels.

(3) You can go to the front desk of the designated general outpatient medical institutions in the city or the social security office window of the insured person with the electronic voucher of the health insurance or social security card or valid ID card to choose points on behalf of your family.

11. What are the payment ratios for different levels of medical insurance designated medical institutions?

The payment ratio is the proportion of the medical insurance fund for the participants to share the medical expenses within the policy scope. The new policy in accordance with the health sector to confirm the level of medical institutions on the health insurance designated medical institutions for the division, for different levels of designated medical institutions set up different health insurance payment ratio, as follows:

(1) Employee health insurance:

first-class medical and health institutions, the first level of the following nonprofit medical and health institutions 90%;

second-class medical and health institutions 70%;

third-class medical and health institutions 50%;

first-class medical and health institutions, the second-class medical and health institutions 70%;

second-class medical and health institutions 70%;

third-class medical and health institutions 50%;

60% of other health care institutions below the first level.

(2) Resident health insurance:

90% of the first-class medical and health institutions, non-profit medical and health institutions below the first level;

70% of the second-class medical and health institutions;

40% of the third-class medical and health institutions;

50% of the other medical and health institutions below the first level.

12. catalog of costs within the scope of the medical insurance included in the proportion?

The medical insurance catalog stipulates the scope of medicines, diagnostic and therapeutic items, and medical consumables that can be paid by the medical insurance fund, which is the basis of medical insurance payment, and the scope of the medical insurance catalog of Foshan City is in accordance with the provisions of the national and provincial documents. For the catalog scope of the cost of medical insurance into the proportion of respectively:

(1) Class A drugs into the proportion of 100%, Class B drugs into the proportion of 95%.

(2) Diagnostic and treatment programs included in the proportion of 100%. Among them, the inclusion ratio of items requiring personal out-of-pocket payment as stipulated in the "Guangdong Provincial Basic Medical Insurance Diagnostic and Treatment Items Catalog" is 90%.

(3) The inclusion ratio of medical consumables is 90%. Among them, the inclusion ratio of dialysis treatment materials with a unit price of 500 yuan or less is 100%.

(4) The scope of payment for off-site general outpatient clinics is in accordance with relevant national and provincial regulations.

13. How to understand the annual maximum payment limit of the health insurance general outpatient coordination fund?

(1) The annual maximum payment limit of the health insurance general outpatient coordinating fund refers to the participant's annual enjoyment of health insurance general outpatient treatment, the maximum amount of health insurance coordinating fund can pay.

(2) The provincial government "Guangdong Government Office [2021] No. 56" stipulates: "Employee health insurance general outpatient co-ordination of the annual maximum payment limit is not less than 2% of the average annual salary of urban on-the-job workers in the city above the local level," Foshan City, by The annual maximum payment limit for retired workers is increased by 10% on the basis of that for active workers. Resident medical insurance general outpatient co-ordination fund annual maximum payment limit of 80% of the annual maximum payment limit of the general outpatient co-ordination fund of the in-service employee medical insurance.

(3) In order to support the work of family doctor service, the annual maximum payment limit is increased by 10% on the basis of the aforementioned standard for participants who have selected only one primary healthcare institution as the designated healthcare institution for outpatient service and signed a family doctor service agreement with it.

14. What is health insurance personal account? What is it for?

(1) The individual account of medical insurance refers to the individual account of basic medical insurance, which is used to record and store the funds of the individual account of the insured.

(2) According to the current national and provincial policies, the employee health insurance by the employer and the individual **** the same contributions, the establishment of health insurance fund account and personal account. Resident medical insurance does not establish medical insurance individual account.

(3) In-service employees health insurance personal account by individual contributions to the retired workers in accordance with a fixed amount from the integrated fund. It can be used to pay for the medical expenses incurred by the participant, his/her spouse, parents and children at the designated medical institutions or designated retail pharmacies, the expenses incurred by the participant at the designated retail pharmacies for the purchase of medicines, medical devices and medical consumables, the individual contributions of the spouse, parents and children to the resident's medical insurance, etc., and the contributions of the participant himself/herself who has not yet reached the minimum number of years of contribution to the employee's medical insurance at the time of his/her retirement, as well as Other expenses in accordance with national and provincial regulations.

15. What is the "health insurance electronic voucher"?

15.

The e-voucher for health insurance is issued by the national health insurance information platform, based on the basic health insurance information base for all participants to generate the health insurance identification electronic media, with safe and reliable, authentication and other important features.

Participants can enjoy all kinds of medical insurance services through the health insurance e-voucher, including health insurance identity verification, health insurance payment record query, medical purchase of medicines using health insurance personal account payment, health insurance personal account consumption records and balance query, foreign medical record, residents' health insurance suspension, designated medical institutions query, etc., the business scenario is very rich, and truly realize the health insurance "data", "more running, less running for the masses". The goal of "more data, less running" is really realized.