August 19, 2022, the Beijing Municipal Bureau of Medical Insurance issued a document "on the adjustment of the city's urban workers' basic medical insurance related policy notice", the document on Beijing's medical insurance policy has made great adjustments, let's take a look at what changes.
Change 1, health insurance personal account funds can not be withdrawn
In accordance with the requirements of the state for personal account funds dedicated funds, since September 1, 2022, personal account funds to implement the management of the book, dedicated funds, participants can not be withdrawn.
Previously, some of the money paid by Beijing workers for health insurance premiums would be deposited in the health insurance passbook, and participants could withdraw cash directly from the passbook without any restrictions.
This policy is very humane, because young people are in good health, almost no spending on medical care, even according to the minimum base contribution, health insurance passbook every year there are more than a thousand into the account.
But from September 1, 2022 onwards, the individual account funds to implement the bookkeeping management, the insured person can not be free to withdraw, only "directed use" - to buy drugs or see a doctor.
In fact, there are only two cities that support cash withdrawals: Beijing and Tianjin.
On December 31, 2021, the General Office of the Tianjin Municipal People's Government issued the "Implementation Measures on Improving the Basic Employee Medical Insurance Outpatient *** Relief Guarantee System," which stipulates that:
From January 1, 2022 onwards, the funds in the individual accounts of the employees' medical insurance will no longer be credited to the bank cards, but will be credited to their individual accounts for the purpose of buying medicines.
So after the policy adjustments in these two cities, they are in line with the rest of the country's health insurance policies.
Beijing's participants do not have to rush to cash, the policy is September 1, 2022, before the money has gone into the personal account, the participants at any time can be withdrawn, after September 1, the money is no longer transferred to the medical insurance passbook, the implementation of the bookkeeping management of the funds for special purposes, can not be free to withdraw, but the medical passbook can be used as a participant tied to the commissioning of a bank account for the manual reimbursement, the second reimbursement The company's business is a very important part of the company's operations, and the company's business is very important to the company's success.
In addition to this, the money in the health insurance card can be taken out in these cases:
If the participant has settled abroad and has canceled his/her account, the social security center will return the money in the individual account of the pension insurance and medical insurance to him/her; if the participant dies during the period of the insurance, the money in the individual account of the pension insurance and medical insurance can be inherited by all of his/her beneficiary or legal heir; there is also the case that the money in the individual account of the pension insurance and medical insurance can be taken out by all of his/her beneficiary or legal heir. Legal heirs to inherit; there is another situation, that is, cross-coordinated areas of mobile employment, but can not handle the balance of the individual account of health insurance transfer procedures, you can take out the balance; the required information and processing procedures may vary from place to place, the specific system to the local policy shall prevail, the need for friends can call the social security hotline 12333 for advice.
Here's a reminder, if you meet any individual or organization claiming to be able to withdraw the amount of social security personal account in advance, please do not believe it, and beware of being deceived,
Change 2, the amount of money credited to the individual health insurance account is reduced
From September 1, 2022, all the basic medical insurance premiums paid by the employed workers are credited to the personal account, and the crediting standard is the amount of money paid to the personal account. The basic medical insurance premiums paid by employers are all credited to the integrated fund. Retiree personal accounts continue to be transferred from the integrated fund at a fixed amount, the specific transfer standard: less than 70 years of age at 100 yuan / month standard transfer, 70 years of age (including) and above at 110 yuan / month standard transfer.
This policy change mainly affects the active workers, before the unit to pay the health insurance premiums of 0.8% to 2% is credited to the personal account and can be freely withdrawn, are now gone, so the active workers every month health insurance personal account will be part of the money accounted for than before will be reduced.
For example, 35-year-old workers, wages of 10,000 yuan, the policy adjustment before the monthly health insurance personal account (2% + 0.8%) × 10,000 = 280 yuan, the policy adjustment after the monthly health insurance account 2% × 10,000 = 200 yuan; 35 ~ 45-year-old workers, the same wages of 10,000 yuan, the policy adjustment before the monthly health insurance personal account (2% + 1%) × 10,000 = 300 yuan, the policy adjustment after the individual account. 10,000 = 300 yuan, 200 yuan after the policy adjustment; employees over 45 years old, the same salary of 10,000 yuan, the policy adjustment before the monthly health insurance personal account (2% + 2%) × 10,000 = 400 yuan, 200 yuan after the policy adjustment. This policy change mainly affects the active workers, before the unit to pay the health insurance premiums have 0.8% to 2% is credited to the personal account and can be freely withdrawn, are now gone. How can the insured check their personal accounts?
From September 2022 onwards, from the 1st to the 5th of each month, health insurance agencies will complete the transfer of funds from the personal accounts of active employees and retirees according to the collection of health insurance premiums.
After that, insured persons can check the transfer, settlement and use of individual account funds on the "I want to check" menu of Beijing's health insurance service platform, on the official website of the Beijing Municipal Bureau of Medical Security, or at the window of each district office.
Change 3: Individual account funds can be used for family **** relief
Since December 1, 2022, the individual accounts of insured persons can be used to pay for the expenses incurred by family members who have been filed for record to seek medical treatment at designated medical institutions or to purchase medicines, medical equipment and medical consumables at designated retail pharmacies, and can also be used to purchase supplemental medical insurance (at this stage, this refers to the supplementary medical insurance) in Beijing for the person himself or for his filed family members. You can also purchase Beijing Supplementary Medical Insurance (at this stage, it specifically refers to the purchase of Beijing Universal Health Insurance) for yourself and your family members of record.
Previously, individual health insurance accounts could only be used for reimbursement of one's own medical expenses, but as of December 1, 2022, the balance of the individual employee's health insurance account for all years in Beijing can now be used by one's spouse, parents, and children in addition to one's own use. The *** enjoyment of the medical insurance balance not only reduces the medical expenses of the insured families, but also improves the utilization rate of the medical insurance account balance.
There are two conditions for family members to use a participant's personal account:
First, the "****jeward" needs to be enrolled in Beijing's basic medical insurance (which is not available to those who are insured in foreign provinces or cities); and second, it must be filed, and the participant can only use the funds from his or her own personal account in the order of the filing. After the participant has used the funds in his/her personal account, he/she can use the account funds of his/her spouse, parents and children according to the order of filing***. Filing method:
On October 15, 2022, the insured person can apply for the filing of ****ji use through the Beijing health insurance public ****service platform, the official website of Beijing Municipal Bureau of Medical Security, and the window of each district agency, and after the filing is successfully completed, since December 1, 2022, he or she can ****ji use of the funds of the personal account.
The ****jewardship recipients can make changes to the order of the ****jewardship account through the public service platform of the health insurance, the official website of the Beijing Municipal Bureau of Medical Security, or the window of each district's handling agency.
Change 4: Elimination of outpatient emergency treatment cap line
Since January 1, 2023, there will no longer be a maximum payment limit for outpatient treatment under the employee health insurance, and the reimbursement ratio will remain unchanged for reimbursement under 20,000 yuan; for reimbursement above 20,000 yuan, 60% will be reimbursed for active employees; and 80% will be reimbursed for retired employees (including the unified supplemental medical insurance for retired employees), with no cap on the maximum payment limit.
The following chart shows the current reimbursement standards for urban workers' health insurance in Beijing, with a starting line of 1,800 yuan for active employees and 1,300 yuan for retirees, and a maximum of 20,000 yuan per year for those exceeding the starting line standard:
This policy adjustment may not have much impact on many young people. Because many young people are in good health, they can't go to the hospital more than a few times a year, and they may not even reach the starting line.
But for some frail and sick people, especially the elderly, it will be very useful. Some patients, who need long-term medication and regular checkups, the 20,000 yuan outpatient cap line is simply not enough and can easily be exceeded, and from next year, this part of the medical expenses can also be reimbursed by the medical insurance support.
According to official calculations, the change is expected to benefit 170,000 insured people each year and reduce the burden on them by about 1 billion yuan.
Change 5: Reducing the starting line for employees' major illnesses
The starting standard for major illness medical insurance has been reduced from 39,525 yuan to 30,404 yuan, which is the same as the starting standard for urban and rural residents' major illness insurance, and the threshold is even lower. In addition to the basic medical insurance for urban and rural workers, 60% of the total medical expenses within the range of 30,404-80,404 yuan will be reimbursed, and the portion of the total expenses higher than 80,404 yuan will be reimbursed 70%, up to an unlimited amount.
It is expected to benefit 35,000 participants annually and reduce the burden on participants by 120 million yuan.