The scope of reimbursement of Inner Mongolia Medical Insurance is very broad, including diagnostic and therapeutic equipment and medical materials, therapeutic items, covering pacemakers, artificial joints, artificial crystals, hemodialysis, peritoneal dialysis, vascular stenting of the body replaced by an artificial organ, the body of the material placed, all kinds of organ transplantation or tissue transplantation of the organ or tissue sources, all kinds of infertility (pregnancy), sexual dysfunction, as well as a variety of scientific research, clinical verification of the treatment items. Tissue source, a variety of infertility (pregnancy), sexual dysfunction diagnostic and treatment programs, as well as a variety of scientific research, clinical verification of the diagnostic and treatment programs.
And the Inner Mongolia medical insurance covers all urban household registration population, everyone can participate in medical insurance. The Inner Mongolia medical insurance covers all insured persons, and as long as they are sick, they are able to be reimbursed regardless of whether they are outpatient or hospitalized, and they can be covered for the same disease again without an increase in premiums. The reimbursement ratio of hospitalization expenses within the policy for urban workers and residents in Inner Mongolia Autonomous Region has reached 84.2% and 70.9% respectively, which is higher than the national average of 81% and 62%. At the same time, the maximum payment limit for hospitalization expenses under the policy of the region's urban workers' and residents' medical insurance has reached six times the average salary of local social workers and the disposable income of the residents, and neither of them is less than 60,000 yuan. The outpatient reimbursement ratio of urban residents' health insurance reaches more than 50%, and financial subsidies at all levels reach 200 yuan per person per year.
In Inner Mongolia, medical insurance is characterized by low contributions, wide coverage, comprehensive coverage and high reimbursement, and has formed an all-round, multi-level protection system.
Legal basis
"Inner Mongolia Autonomous Region level workers basic medical insurance outpatient *** relief protection implementation rules"
Chapter I General Provisions
Article 1, the in-depth implementation of the "State Council on the establishment of a sound workers basic medical insurance outpatient *** relief protection mechanism of the guiding opinions "(State Office of the State Council [2021] No. 14) spirit, and constantly improve the regional level of employees basic medical insurance outpatient cost protection mechanism, steadily improve the level of protection, reduce the burden of outpatient medical care of insured persons, according to the "General Office of the People's Government of the Inner Mongolia Autonomous Region on the establishment of a sound outpatient *** relief protection mechanism of basic medical insurance for employees implementation of the views" (Nei Zhengban Fa [2021] No. 82) and the Autonomous Region Medical Security Bureau Autonomous Region Department of Finance "on the establishment of perfect employees basic medical insurance general outpatient protection system notice" (Inner Medical Insurance Office issued [2021] No. 42), combined with the autonomous region at this level of the actual, the formulation of the implementation of the rules.
Second, the implementation of the rules apply to participants in the basic medical insurance of employees at the regional level.
Chapter 2, the person account management.
Article 3, October 1, 2022 onwards, the basic medical insurance premiums paid by the participating units are all credited to the integrated fund. Individual accounts of active employees, according to the basic medical insurance premiums paid by 2% of the base amount of their participation in the insurance premiums are credited. The individual accounts of retirees are gradually adjusted to be transferred from the integrated fund on a flat-rate basis, starting from October 1, 2022, with the average basic pension of the whole region in 2021 as the base, at a rate of 3%, and from 2023 onwards, at a rate of 2%.
Article 4: The personal account is mainly used to pay for the out-of-pocket expenses within the policy scope incurred by the insured person at the designated medical institutions or retail pharmacies. It can be used to pay for the medical expenses incurred by the insured person himself, his spouse, his parents and his children at the designated medical institutions, and the expenses incurred by the insured person for the purchase of medicines, medical equipments and medical consumables at the designated retail pharmacies. It can also be used for the personal contributions of spouses, parents and children to the Resident's Medical Insurance, Employee's Large Medical Expense Subsidy and Long-term Care Insurance.
Article 5, the person account 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.
Article 6, the whole integrated fund and personal account structure, the increase in the integrated fund is mainly used for outpatient **** financial protection, improve the outpatient treatment of the insured.
Chapter III general outpatient co-ordinated treatment protection
Article 7, the insured person in the designated medical institutions, in line with the medical policy within the scope of the medical expenses, included in the general outpatient co-ordinated protection.
Article 8: When the insured persons enjoy the general outpatient coordinated treatment, they shall use the electronic vouchers of medical insurance and social security cards and other valid vouchers to settle the medical expenses, and the medical expenses exceeding RMB 1,000 or more within the scope of the policy that are accumulated in the funds of the individual account and cash within an annual period shall be paid by the coordinated fund according to the proportion, and the proportion of the third-level medical institutions shall be 60%, the proportion of the second-level and the following medical institutions shall be 80%, and the proportion of the retirees shall increase by 5 percentage points. , with an increase of 5 percentage points for retirees. The annual maximum payment limit is 5,000 yuan for active employees and 6,000 yuan for retirees. Individual account family members **** relief use of part of the general outpatient coordination is not included in the starting standard.
Article IX, through the outpatient co-ordination payment amount into the annual maximum payment limit of the integrated fund.
Article 10, eligible designated retail pharmacies to provide medication protection services into the scope of outpatient coverage, support for insured persons with designated medical institutions dispensing prescription in designated retail pharmacies settlement and dispensing, give full play to the designated retail pharmacies convenient, accessible role. Explore the inclusion of qualified "Internet+" medical services into the scope of medical insurance payment.
Chapter IV Settlement of Expenses
Article 11, through the outpatient outpatient coordinated settlement of expenses to implement the "Inner Mongolia Autonomous Region basic medical insurance, work-related injury insurance and maternity insurance drug directory," "Inner Mongolia Autonomous Region basic medical insurance diagnosis and treatment items range," "Inner Mongolia Autonomous Region basic medical insurance for urban workers medical services and facilities range and payment standards" of the scope of payment and standards, beyond the scope of the The medical insurance fund shall not pay for the expenses beyond the scope.
Article 12, through the outpatient outpatient coordinated expenses for the implementation of immediate settlement, the insured person in the designated medical institutions, should be used in the electronic vouchers and social security card and other valid vouchers for direct settlement, the individual part of the individual account funds or cash payments, the coordinated fund to pay the part of the designated medical institutions by the first bookkeeping, and regularly through the medical insurance information platform and the autonomous region health insurance service center for clearing. The medical insurance information platform and the autonomous region medical insurance service center to carry out liquidation.
Article 13: The outpatient medical personnel and those who have been filed for cross-provincial resettlement of retirees, long-term residents of other places, permanent staff of other places, and referrals of other places, who have incurred general outpatient coordinated expenses in accordance with the provisions of the designated medical institutions in other places, will use the electronic vouchers of medical insurance and social security cards and other valid vouchers to settle the expenses directly; if the expenses can't be settled directly, the individuals will first advance the expenses in cash, and will then go to the designated medical institutions with the relevant vouchers and details of the expenses in the later stage. Relevant bills and expense details will be submitted to the Autonomous Region Health Insurance Service Center for reimbursement.
Chapter V Supplementary Provisions
Article 14, the implementation of the rules shall come into force on October 1, 2022, and any inconsistency with the implementation of these rules shall be implemented in accordance with the provisions of the implementation of these rules. State and autonomous regions have other new regulations, from its provisions.