Ordos medical insurance outpatient reimbursement policy

September 29, "Ordos City to establish and improve the implementation of basic health insurance for employees outpatient ****ji protection rules" press conference was held, at which the general public concerned about the issue of answering reporters' questions.

Reporters at the press conference was informed that from October 1, Ordos City began to implement the general outpatient co-ordination mechanism of employee health insurance, general outpatient costs into the employee health insurance co-ordination fund to pay, and further reduce the masses, especially to reduce the burden of outpatient medical costs of the elderly.

It is understood that from October 1 this year, Ordos City will begin to implement the general outpatient co-ordination mechanism of employee health insurance. What benefits will the general outpatient coordination bring to the insured workers?

A: The benefits are mainly reflected in: employee health insurance outpatient coverage expanded. The original mechanism of our protection is a chronic disease outpatient can only be included in the integrated reimbursement, general outpatient through the individual account to protect. After the reform, common diseases and multiple diseases can be included in the overall reimbursement. Simply put, common headaches and colds can now be reimbursed. As a result, the scope of outpatient coverage has been expanded, and health insurance benefits are more fully protected. At the same time, the establishment of the general outpatient co-ordination system, the state and autonomous regions in accordance with the needs of retirees, but also special provisions for retirees inclined policy. According to the spirit of reform of the state and autonomous region, Ordos City has established general outpatient co-ordination policy which stipulates that the reimbursement ratio of retirees is increased by 5 percentage points compared with that of active employees, and the annual maximum payment limit is increased by 1,000 yuan compared with that of active employees. This is a pragmatic initiative of the health insurance reform to cope with the aging of the population, which is also a good policy for retirees, who benefit to a greater extent and a wider range of benefits.

After the implementation of the employee health insurance outpatient ****ji protection policy, general outpatient reimbursement into the scope of reimbursement, so the employee health insurance contributions will increase as a result?

A: After the implementation of the employee health insurance outpatient **** relief protection policy, the employee health insurance premiums will not increase. Individuals and units of the proportion of health insurance contributions remain unchanged. Outpatient **** financial protection is through the adjustment and optimization of the fund structure to improve outpatient treatment protection. Optimization of the fund structure is a reform of the individual account crediting method, adopting the approach of "vacating the cage and exchanging the bird", implementing the system transition under the existing conditions, and establishing the general outpatient protection mechanism, which further strengthens the function of outpatient ****ji protection. Therefore, the reform will not only not increase the burden of participants and units of the contribution, the efficiency of the use of funds will also be greatly activated and enhanced.

It is understood that the health insurance personal account family **** Jinji, can make family members in the health insurance personal account **** Jinji use, so as to reduce the burden of medical costs between family members. How to handle the individual account family ****Ji? The first thing you need to do is to get a good deal on your own personal account, and you'll be able to pay for it.

First of all, the individual account family ****Ji can go to the participating local agency for processing, but also through the online channel: "National Medical Insurance Information Platform" APP, "Inner Mongolia Medical Insurance" APP, WeChat or Alipay. "Inner Mongolia Health Insurance" small program, fill in personal information and "insured workers" account ****Ji authorized to use "commitment letter" for binding. Secondly, after the individual account family **** relief, you can pay for three types of expenses: First, the insured person in the designated medical institutions or designated retail pharmacies in line with the basic medical insurance policy within the scope of the out-of-pocket expenses; Second, the insured person himself, his spouse, parents, children in the designated medical institutions medical expenses incurred by the individual, as well as in the designated retail pharmacies to buy drugs, medical equipment and medical consumables at designated retail pharmacies; and thirdly, the individual contributions of the insured's spouse, parents and children who participate in the residents' medical insurance, the employees' subsidy for large medical expenses, and the long-term care insurance. Finally, the advocacy of the medical treatment, the whole process of using health insurance electronic payment vouchers, enjoy the direct settlement of medical treatment, to reduce the "errand advances" trouble.

See here more clearly ↓↓

"Ordos City to establish and improve the employee

basic medical insurance outpatient ****ji protection

Implementation Rules

First, the basis for the development of

In accordance with the "General Office of the State Council on the establishment and improvement of employee basic medical insurance outpatient ****ji protection mechanism of the guiding opinions" (State Office of the State Council [2021] No. 14), "the Inner Mongolia Autonomous Region People's Government General Office" (State Office of the People's Government of the Inner Mongolia Autonomous Region, General Office of the People's Government of the Inner Mongolia Autonomous Region). General Office of the People's Government of the Inner Mongolia Autonomous Region on the Establishment and Improvement of Employee Basic Medical Insurance Outpatient ****ji Guarantee Mechanism Implementation Opinions" (NeiGeOfficeFa [2021] No. 82), and "Inner Mongolia Autonomous Region Healthcare Security Bureau of the Inner Mongolia Autonomous Region Department of Finance on the Establishment of Improvement of Employee Basic Medical Insurance Ordinary Outpatient Guarantee System" (NeiMedicine Insurance Office of the Inner Mongolia Autonomous Region [2021] No. 42), combined with the requirements of the Erdos City, the actual situation, the formulation of the rules.

Second, the object of application

Ordos City employees basic medical insurance participants.

Third, the main content

(a) personal account management

1. Since October 1, 2022, the combination of basic medical insurance premiums paid by the united account of active employees (including the combination of united account of flexibly employed persons, the same below) personal account in accordance with the base of 2% of their contributions; combination of united account of the retirees (including retired combination of united account of flexibly employed persons, the same below) personal account, gradually adjusted to the unified fund at the rate of 2% of the total amount of contributions. Gradually adjusted to the integrated fund by the fixed amount, to the average basic pension in the region in 2021 as the base, since October 1, 2022, according to the proportion of 3% of the fixed amount of the personal account; since January 2023, the average basic pension in the region in the previous year as the base, according to the proportion of 2% of the fixed amount of the personal account.

2. Individual account payment scope: participants in the designated medical institutions or designated retail pharmacies in line with the basic medical insurance policy within the scope of out-of-pocket expenses; participants themselves and their spouses, parents, children in the designated medical institutions medical expenses incurred by individuals, as well as in the designated retail pharmacies to purchase drugs, medical equipment, medical supplies incurred by individuals to pay the costs The spouse, parents and children of the insured participate in the residents' health insurance, employees' subsidies for large medical expenses, long-term care insurance and other personal contributions.

3. Individual accounts shall not be used for public **** health costs, sports and fitness or health care consumption and other expenditures that do not fall within the scope of basic medical insurance coverage.

(B) general outpatient co-ordination system

1. The outpatient multi-morbidity, common diseases into the scope of payment of the medical insurance co-ordination fund, the implementation of the cost-based protection mechanism.

2. General outpatient co-ordination of the scope of payment for: in line with the basic medical insurance policy within the scope of drugs, medical consumables and medical services.

3. General outpatient treatment standards:

(1) Starting standard: annual starting standard of 1000 yuan.

(2) Maximum payment limit: the annual maximum payment limit of 5,000 yuan for active employees, 6,000 yuan for retirees.

(3) Payment ratio: above the starting standard, the maximum payment limit below the policy scope of the cost, the third-level medical institutions outpatient integrated fund to pay 65%, the second-level medical institutions outpatient integrated fund to pay 75%, the first-level medical institutions outpatient integrated fund to pay 85%, the integrated fund for retirees to pay the proportion of the above basis increased by 5 percentage points.

4. The starting standard of payment for general outpatient coordination can be paid by using the personal account.

5. Expense settlement: the insured person in the designated medical institutions for medical treatment of general outpatient co-ordination costs should be held by the health insurance electronic voucher (or social security card) instant settlement.

6. The medication protection services provided by qualified designated retail pharmacies will be included in the scope of outpatient protection, supporting the settlement and dispensing of medication by insured persons with prescriptions dispensed by designated medical institutions at designated retail pharmacies, and giving full play to the convenient and accessible role of designated retail pharmacies.

Fourth, the implementation time

These rules shall come into force from October 1, 2022 onwards.