1. The unified health insurance reimbursement rate will be adjusted to 80%, and the items to be covered will mainly include inpatient expenses, outpatient expenses, and drug expenses;
2. Increase inpatient reimbursement items, and the health insurance agencies will add large equipment inspection and medical institution management expenses to the inpatient reimbursement items to better protect patients' medical rights and interests;
3. Increase the outpatient coordinated treatment, the insured residents in the second level and the following designated medical institutions in the general outpatient medical expenses, the reimbursement of a year of the ceiling line of 150 yuan / person year, reimbursement rate of 60%, the implementation of network direct settlement. In addition, according to the current health insurance reform has been completed in the region, health insurance personal account into the account may be less, because the reform is no longer transferred to the 30% borne by the enterprise unit, just transfer only 2% deducted by the individual. The payment limit. 2023 residents health insurance integrated fund annual maximum payment limit of the first tranche of 200,000 yuan, the second tranche of 250,000 yuan, 2023 adjusted to "residents health insurance integrated fund annual payment limit of 250,000 yuan.
Medicare coverage is as follows:
1, the drugs are divided into three categories of A, B and C, of which Category A drugs are within the scope of the medical insurance, so only Category A drugs can be reimbursed by the medical insurance, while Category B and C can not be reimbursed;
2, reimbursement mainly refers to the insured person, in the medical insurance designated institutions for diagnosis and treatment and nursing care, and in the process The reimbursement is mainly for the insured's medical treatment and care in the designated hospitals in the process of which the insured's bed charges, emergency bed charges and consultation fees are incurred.
In summary, the content of the health insurance reimbursement policy will continue to be adjusted and improved according to the actual situation, in order to better meet the public's medical needs.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in line with the basic medical insurance drug directory, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.