1. Reimbursement of inpatient and outpatient specific items within the medical insurance, i.e., the insured person's personal out-of-pocket medical expenses (including the starting line of the major disease insurance) remaining after reimbursement by the Xuzhou Municipal Medical Insurance after consultation at the designated medical institutions of the medical insurance and the personal out-of-pocket expenses within the limit of medical insurance reimbursement of the 51 nationally negotiated medicines used for outpatient treatment according to the disease collection and payment fees are reimbursed 60% of the annual deductible of 19,000 yuan, and the reimbursement limit is one million yuan. After deducting the annual deductible of 19,000 yuan, 60% of the individual out-of-pocket expenses within the reimbursement limit of health insurance can be reimbursed, with a reimbursement limit of one million yuan;
2. Reimbursement of out-of-pocket expenses outside of health insurance can be reimbursed by 50% after deducting the annual deductible of 20,000 yuan, with a reimbursement limit of 500,000 yuan;
3. Medical expenses incurred by the insured person who is included in the Jiangsu Provincial Medication Guarantee Mechanism of Rare Diseases and who has used medicines stipulated by the Medical Protection Bureau of Jiangsu Province for the purpose of reasonable and necessary treatments. After the reimbursement of medical expenses incurred by the insured person for the use of medicines prescribed by the Jiangsu Provincial Medical Protection Bureau for reasonable and necessary treatment, and after the reimbursement by the Rare Disease Medication Guarantee Fund, medical treatment and charitable assistance, the insured person will be reimbursed for 45% of the remaining medical expenses that need to be paid by him/her at his/her own expense, with a limit of two hundred thousand RMB after deducting the annual deductible amount of fifty thousand RMB.
In order to help Xuzhou city multi-level medical insurance system construction, enhance the level of medical insurance for the people of Xuzhou. The Xuzhou Municipal Bureau of Medical Protection, together with the Municipal Bureau of Finance, the Municipal Bureau of Civil Affairs, the Municipal Office of Poverty Alleviation, the Municipal Branch Office of Banking and Insurance Supervision and other eight departments, guided a number of insurance companies to jointly launch the "supplemental medical insurance for Xuzhou people - Huixu Insurance". In the first year of its launch, the number of participants in the city's "Huixu Insurance" was nearly 1.1 million, with the coverage rate of citizens exceeding 10%, setting a new record for the number of participants in non-policy health insurance in Jiangsu Province.
Comprehensive improvement of protection responsibility:
In 2022, "Huixu Insurance" lowered the starting line of medical insurance coverage and "national negotiation drugs" from 20,000 yuan to 19,000 yuan; the reimbursement types of "national negotiation drugs" from 20,000 yuan to 19,000 yuan; and the reimbursement types of "national negotiation drugs" from 20,000 yuan to 20,000 yuan. The types of reimbursement for "nationally-talked medicines" have increased from 22 types in 2021 to 51 types, including medicines for rheumatoid arthritis, hepatitis C, hemophilia and other diseases; a new 200,000-dollar limit has been added to the province's coverage for rare diseases; and value-added services have been increased to five types: setting up a column on health management, popularizing health knowledge, and providing the public with more convenient and comprehensive health management services.
Restrictions on pre-existing conditions fully open
In FY2021, only seven rare diseases were restricted, and in FY2022, pre-existing conditions were fully opened up, with no restriction on the history of any disease for the insured, and claims can be made if they meet the agreed scope.
Broader coverage:
The threshold for participation in the 2022 "Huixu Insurance" has been further lowered. Firstly, as long as the insured is a Xuzhou health insurance participant, he or she can purchase "Huixu Insurance" for himself or herself and his or her spouse, children, parents, parents-in-law, and parents-in-law who are enrolled in the health insurance in the foreign country. "The second is that foreign health insurance participants who work, live and study in Xuzhou can also buy "Huixu Insurance" and enjoy the same protection as Xuzhou's local health insurance participants.
More optimized payment process:
In 2021, the "Huixu Insurance" has made innovations in the payment channel, and Xuzhou employees' health insurance participants can use the balance of their individual accounts to pay for their own and their family members' insurance. However, in 2021, you will have to pay out of pocket first, and then be refunded after coverage. 2022, the payment system has been optimized so that Xuzhou employee health insurance participants can pay for themselves, their children, their spouses, and both parents of the family, without having to pay in advance and then be refunded, by making an appointment to pay.