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Further reading: Nanjing will realize the unification of residents' medical insurance as soon as next year.
Recently, Ms. Li, who lives in Pukou, took her son to the Provincial Hospital of Traditional Chinese Medicine to see rhinitis. At the time of registration, Ms. Li, who was preparing to swipe her medical insurance card, was told that Pukou's card could not be swiped in the urban area and she had to go back to go through the formalities. Ms. Li didn't want to do that, so she paid the bill herself. Situations like Ms. Li's son also exist in Jiangning and other districts. Recently, the reporter learned from the Medical Insurance Department of Nanjing Social Security Center that Nanjing has formulated a timetable for the merger of urban and rural residents' medical insurance. As soon as the end of next year, after the city's medical insurance is unified, the obstacles to the new rural cooperative medical insurance card in Laowu County will no longer exist.
There is a unified timetable for medical insurance for Nanjing residents.
For a long time, the medical insurance for urban residents and the new rural cooperative medical system were managed by the people's society and the health department respectively, and the systems were relatively independent. Previously, since June 20 16, 1 year, the medical insurance of 3.87 million urban workers in Nanjing has been unified, and Gaochun and Lishui were in line with the main city on July 1 day of that year. The remaining 1, 7 1, 000 insured residents of the new rural cooperative medical system still have the problems of inconvenient cross-regional medical treatment and inconsistent payment and reimbursement standards.
The relevant staff of the Medical Insurance Department of Nanjing Social Security Center introduced that some rural residents in Gaochun, Lishui, Jiangning, Pukou, Liuhe Laowu County, Yuhuatai and Qixia participated in the new rural cooperative medical system, not residents' medical insurance. This separated democracy is mainly for the elderly, newborns, children, primary and secondary school students and college students. This year, Nanjing listed the timetable for the integration of medical insurance for urban and rural residents. It is estimated that by the end of 20 18, the city's coverage, financing policy, guaranteed treatment, medical insurance catalogue, fixed-point management and fund management will be realized. Six unification? , eliminate differences in the same city.
After the merger of medical insurance, the overall treatment will not be reduced.
20 17 medical insurance for urban residents in Nanjing has improved the overall standard without increasing individual contributions. 400 yuan/year for elderly residents (household registration is less than 10 900 yuan/year); 480 yuan/year for other residents (960 yuan/year with household registration less than 10); Students and children per year 150 yuan (including children of migrant workers).
After participating in residents' medical insurance, in terms of enjoying treatment: 50% of the part from 20,000 yuan to 40,000 yuan; 40 thousand yuan to 60 thousand yuan, medical insurance pays 55%; 60,000 yuan to 80,000 yuan, and medical insurance pays 60%; 80,000 yuan to 6.5438+10,000 yuan, and medical insurance pays 65%; For the part of 654.38+ 10,000 yuan, medical insurance will pay 70%.
As for the payment standard of the new rural cooperative medical system, take Pukou District as an example. In 20 17, the household registration personnel in Pukou District paid 260 yuan and the students and children paid 260 yuan every year. Born after 1 in July last year, pay 130 yuan every year. In addition, everyone has to pay 40 yuan for supplementary insurance for serious illness. The cardholders of the new rural cooperative medical system in Pukou have the highest reimbursement rate in community health service centers and service stations, accounting for 85%, and the guarantee compensation is 35%. If you want to see a doctor in the main city of Nanjing, it is limited to 24 designated hospitals in provinces and cities, and referral will be made in hospitals in the first-visit area, otherwise the reimbursement rate will be reduced.
After the unification of residents' medical insurance, this problem does not exist. With a unified medical insurance card in Nanjing, you can swipe your card in hospitals all over the city and enjoy reimbursement immediately without going back to your district for reimbursement. As for the reimbursement ratio, there is a big difference because the policies and regulations of residents' medical insurance and the new rural cooperative medical system are different. The proportion of hospitalization payment of the new rural cooperative medical system is lower than that of residents' medical insurance, and it is mainly inclined to community health service centers. Overall, residents' medical insurance hospitalization treatment is higher than that of the new rural cooperative medical system.
The staff of the medical insurance department said that after the merger of medical insurance, the benefits enjoyed tend to be high and low. However, it is still necessary to determine the unified standards of the whole city from the perspective of medical insurance affordability. In accordance with the requirements of Nanjing integration, we should follow the principles of moderate security, balance of payments, and no reduction in overall treatment, and do a good job in linking medical insurance treatment policies. To further improve the outpatient co-ordination policy, the fund payment ratio is not less than 50% in principle. Gradually unify the minimum payment standard, payment ratio and maximum payment limit of hospitalization medical expenses for urban and rural residents, and the average payment ratio of funds within the policy scope is about 75%.
Medical treatment in different places must be filed before reimbursement.
In addition to the unified network settlement of urban and rural medical insurance, medical insurance cards in different places have also affected a large number of people.
On New Year's Day of 20 17, online settlement of medical treatment in different places in Jiangsu Province was implemented. Nanjing people who go to other places to see a doctor, or foreigners who come to Nanjing to see a doctor, can swipe their medical insurance cards at local hospitals and settle accounts immediately.
However, in the actual process of seeing a doctor, many people still can't enjoy the convenience of seeing a doctor in different places because they don't understand the policy. The relevant staff of the Medical Insurance Department of Nanjing Social Security Center introduced that it is necessary to go to a designated hospital for medical treatment in different places.
At present, the number of designated hospitals in Nanjing has increased from 10 to 122. In addition, medical personnel from other places in Nanjing must hold the examination and approval materials for medical treatment in other places issued by the local medical insurance agency, get the Nanjing social security card at the social security card business card printing outlets in downtown Nanjing, and open the function of medical treatment settlement in different districts and streets, so as to complete these procedures and truly enjoy the benefits of medical treatment settlement in different places.
Similarly, when Nanjing people go to a foreign hospital for medical treatment, they also need to fill out an application form for medical treatment in a different place at the medical insurance agency in Nanjing. After examination, they can get the social security card in the social security card business card printing department of the medical treatment place, and open the settlement function in different places.
In another case, if you go to a designated hospital in Nanjing for medical treatment in a different place, but you don't swipe your card or realize online settlement, the cardholder needs to go back to the agency in the insured place and submit reimbursement according to the sporadic reimbursement policy. Once you leave Nanjing to live in the original insured place, you need to cancel the medical treatment procedures in different places in Nanjing, otherwise it will affect the medical treatment and reimbursement in the original insured place.
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