Starting from July 1st, these expenses will be reimbursed by medical insurance!
The People’s Daily Health Client found that recently, Anhui, Hebei, Yantai, Shandong, Dalian, Liaoning and other places have issued policies to expand the payment scope of some medical services and medical consumables, including medical insurance for day ward treatment Payment, medical insurance payment for dental medical services, medical insurance payment for medical consumables, etc.
Dalian, Liaoning: Medical insurance can also reimburse for day ward treatment
"From July 1, 29 types of day surgery, 20 types of day chemotherapy regimens and 23 Daytime high-value drug injection treatment is included in Dalian’s medical insurance payment management, and patients treated in day wards can also be reimbursed by medical insurance.” On June 30, the Information Office of the Dalian Municipal People’s Government held a news conference on the pilot work of Dalian’s medical insurance payment reform for day ward treatment. mentioned in the press conference.
The patient is treated during the day and goes home at night, which not only reduces the burden of medical treatment, but also eliminates the inconvenience of the patient's family members accompanying him.
According to the "Notice on Carrying out the Pilot Work on the Reform of Medical Insurance Payment for Day Ward Treatment" issued by the Dalian Municipal Medical Security Bureau, the types of day surgery include inguinal hernia repair, colon and rectal polyp resection, and ureteral surgery. There are 29 types of ambulatory surgery including stone lithotripsy and phacoemulsification for senile cataract with intraocular lens implantation. 20 daytime chemotherapy regimens for five common malignant tumors of breast cancer, lung cancer, intestinal cancer, gastric cancer and esophageal cancer have been refined. The necessary inspection and disposal costs for 23 high-value drugs that need to be used via intravenous, intrathecal and other administration routes, including cetuximab (injection) and nosinaxin sodium (injection), are included in the daily The scope of medical insurance reimbursement for each ward.
Ma Dan, deputy director of the Medical Services Department of the Dalian Municipal Medical Security Bureau, pointed out: “For day surgeries that are within the scope of the disease catalog for insured persons in Dalian in the day ward, the deductible standard (i.e. threshold Fees) and medical insurance reimbursement rates are implemented according to hospitalization policies for various types of patients. Among them, there are no deductible standards for daytime chemotherapy and daytime high-value treatment for senile cataract intraocular lens implantation and intravitreal drug injection for macular degeneration. There is no minimum payment standard for drug injection treatment (that is, there is no threshold fee). Among them, the cost of daytime high-value drugs is reimbursed according to the province’s unified high-value drug payment policy. The medical expenses of chemotherapy during the period are implemented according to the hospitalization reimbursement ratio for various types of personnel."
Anhui Province: 15 dental medical service items are included in the medical insurance
"Including tooth desensitization treatment and fluoride to prevent caries. Fifteen dental medical service items, including treatment, scaling, and local oral irrigation and medication, have been newly included in the payment scope of Anhui Provincial Medical Insurance. "Anhui Province has issued the "Notice on the Inclusion of Some Dental Medical Service Items in the Payment Coverage of Medical Insurance and Work Injury Insurance." Notice", effective from July 1, 2022, the number of dental medical service items included in medical insurance reimbursement in Anhui Province will increase to 293.
In the next step, the Anhui Provincial Medical Insurance Bureau will gradually reduce the cost of oral medical care for patients by implementing the province's unified financial security policy for employee medical insurance outpatient clinics, participating in centralized purchasing to reduce the prices of some high-value dental medical consumables, etc. Medical expenses.
Hebei Province: 50 medical service items and 242 types of medical consumables are included in the scope of medical insurance payment
“50 medical service items and 242 types of medical consumables are included in the payment scope of medical insurance. "Managed in accordance with Category B." On June 28, the Hebei Provincial Medical Insurance Bureau issued the "Notice on Carrying out a Pilot Project at the Provincial Level to Incorporate Certain Medical Services and Medical Consumables into the Scope of Medical Insurance Payment", which will be implemented from July 1 during the pilot period. for half a year.
The People’s Daily Health Client found that the 50 pilot medical projects involve magnetic resonance imaging cardiac function tests, artificial liver treatment, deep brain electrode implantation, and thyroid peroxidase antibody measurement. wait.
On the basis of the implementation of the policies and price limits of the "Hebei Province Basic Medical Insurance Diagnosis and Treatment Items and Medical Service Facilities Catalog" and the "Hebei Province Chargeable Disposable Items Management Catalog (2021 Edition)", "Category A" For medical treatment items and consumables, there is no personal prepayment ratio, and the basic medical insurance co-ordination fund will pay for them in accordance with regulations; for "Category B" medical treatment items and consumables, the insured person will pay 10% out of pocket in advance, and participate in the civil servant subsidy (or 10% supplement) ) personnel, the part paid in advance is not personally borne; "Category C" or "self-paid" diagnosis and treatment items and consumables are all borne by the insured person personally.
Yantai, Shandong: Employees can be reimbursed for general outpatient medical treatment
"From July 1 this year, Yantai City will launch the implementation of the employee medical insurance general outpatient co-ordination system and include outpatient expenses into the employee medical insurance co-ordination system. Fund payment scope will reduce the burden of outpatient medical expenses on insured persons.” On June 29, the Yantai Municipal Medical Insurance Bureau issued a notice on its website.
The notice pointed out that the ordinary outpatient medical expenses incurred by the insured at the designated medical institutions of the Yantai employee medical insurance general outpatient service are in compliance with the medical insurance policy (the expenses incurred by the insured employees are in compliance with the national medical insurance drug catalog, diagnosis and treatment item catalog and General outpatient expenses in the service facility directory) are included in the medical insurance reimbursement.
In a calendar year, the minimum payment standard for designated medical institutions at the first level and below is 500 yuan, and the minimum payment standard for designated medical institutions at the second and third levels is 800 yuan. If the insured person changes designated medical institutions within the year, the cumulative minimum payment standard shall not exceed 800 yuan.
The reimbursement ratio for active employees in designated medical institutions at the first level and below is 70%, the reimbursement rate at the second-level designated medical institutions is 60%, and the reimbursement rate at the third-level designated medical institutions is 50%. The reimbursement rate for retirees is 5 percentage points higher than that for active employees.
In a calendar year, the maximum reimbursement limit for ordinary outpatient medical expenses for active employees and retirees is 1,800 yuan, which will be 900 yuan in 2022.