In accordance with the relevant policies of the state, Hubei Province and the company's relevant requirements, Dongfeng Motor News recently launched a column entitled "New Trends in Medical Insurance Policy", which explains the relevant contents of the medical insurance reform policies at the state, Hubei Province and the company level, and has been widely noticed by the majority of employees. In order to timely answer the concerns of the employees, the working group of localized health insurance reform of DFM has organized the "New Trends in Health Insurance Policy: Seven Questions and Answers", so please pay attention to it.
1, how to realize the "nearness" of employees' medical treatment?
Answer:
After the company's basic medical insurance was incorporated into the unified management of Hubei Province in January 2022 (the specific time is subject to the notification of the Provincial Medical Insurance Bureau), the scope of the insured's access to medical treatment was further expanded to basically cover the major medical institutions in Shiyan, Xiangyang and Wuhan. The list of 79 designated medical institutions and 201 designated retail pharmacies in the region is detailed in:
At present, there are 12 designated medical institutions and 62 designated retail pharmacies in the Wuhan region for the company's basic medical insurance.
2, medical reimbursement how to do "near to do"?
Answer: First, the promotion of health insurance services for the convenience of the people, the abolition of health insurance sporadic reimbursement business acceptance of regional restrictions, the insured person can be selected to the personnel **** enjoy service center Shiyan, Xiangyang, Wuhan, regional window for direct processing.
The second is to vigorously publicize and promote the supplemental outpatient commercial insurance program through the cell phone "online" (WeChat attention "China Life Hubei branch service number" - customer service - WeChat claims - group single claims application - according to the prompt step operation), and strive to increase the rate of online acceptance from the current rate to the current rate. We will strive to gradually increase the online acceptance rate from the current 2.5% to more than 10%. At the same time, in October, we will integrate and upgrade the software and hardware of the Shiyan, Xiangyang and Wuhan regional windows of the Personnel *** Enjoyment Service Center, increase the number of channels for supplementary outpatient commercial insurance business directly facing the insured, and equip the counter with a service satisfaction evaluator to evaluate the service.
3. How can employees' medical expenses be "directly reported"?
A: Supplementary outpatient commercial insurance program will be in the existing Shiyan area of 49 fixed-point direct compensation institutions (see table below), based on the September addition of three (Shiyan area, two, Xiangyang area, one), while Wuhan will also be actively promoted to maximize the convenience of one-stop settlement of insured persons. Advocating the insured personnel close to the fixed-point direct claims institutions for outpatient medical treatment.
After the localization of the basic medical insurance, it will gradually realize the instant settlement of medical treatment in other places for the insured. At present, the company has completed the social security card issuance work, for the next step into the provincial health insurance management to realize the settlement of foreign medical settlement.
4, supplemental outpatient commercial insurance program how to achieve "fast"?
Answer: First, to simplify the claim information, in the second and more claims, without the need to provide ID cards, bank card copies; second is to shorten the time limit for reimbursement of ordinary cases, claims information is complete, from the original 15 working days shortened to 10 working days; third is to advocate the timely submission of claims after medical treatment, to avoid the peak business period. Measures will continue to be taken to shorten the reimbursement timeframe in the future.
5. How do we make it easier for employees to "do less errands"?
A: According to the relevant national policies, combined with the actual supplemental outpatient commercial insurance program, will be in accordance with the principle of rationality, stratified and graded moderate relaxation of the drug limit (special needs for the record first), to reduce the frequency of insured persons to the medical prescribing, so that patients with chronic diseases to buy medicines "less errands". Adjustment program from July 1, 2021 implementation, please pay attention to the follow-up notice.
6. How is the reimbursement for the Supplemental Outpatient Commercial Insurance Program calculated? How many people were reimbursed up to the maximum payment limit of $6,000 in the last health insurance year? What should I pay attention to for the Supplemental Outpatient Commercial Insurance Program?
A: The reimbursement formula for outpatient commercial insurance program is: (total amount of outpatient invoice - the amount paid by the third party - out-of-pocket expenses of medical insurance - other non-covered expenses - the cumulative annual starting line of 1,000 yuan) × 70%.