1, the reimbursement rate of unified medical insurance will be adjusted to 80%, and the items covered mainly include hospitalization expenses, outpatient expenses and drug expenses;
2. Increase hospitalization reimbursement items. Medical insurance institutions will increase the inspection and management fees of large equipment in medical institutions in hospitalization reimbursement projects to better protect patients' medical rights and interests;
3. Improve the overall treatment of outpatient service. For the general outpatient medical expenses incurred by the insured residents in the designated medical institutions at level 2 and below, the top line for reimbursement within one year is 150 yuan/person-year, and the reimbursement ratio is 60%, and direct online settlement is implemented. In addition, according to the areas where the medical insurance reform has been completed, the income of personal accounts for medical insurance may be less, because after the reform, 30% of the burden borne by enterprises will not be transferred, and 2% of the personal deduction will be transferred. Payment limit. In 2023, the annual maximum payment limit of the residents' medical insurance pooling fund is 200,000 yuan in the first file and 250,000 yuan in the second file. In 2023, it was adjusted to "the annual payment limit of the residents' medical insurance pooling fund is 250,000 yuan;
The scope of medical insurance reimbursement includes:
1, medical expenses during rescue;
2. Medical expenses during hospitalization;
3, surgical materials and AIDS;
4. Bed fee: according to local medical insurance standards. Except for those who need to be admitted to ICU intensive care unit due to acute craniocerebral injury and complex organ injury, they should be transferred to general ward immediately after they are out of danger;
5. Rehabilitation physiotherapy fee: according to local medical insurance standards. In principle, there are no more than three kinds, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated;
6, dressing change and rehabilitation function guidance training: according to local medical insurance standards combined with disease needs;
7. Ambulance fee: calculated according to the standard approved by local health department and price department;
8. Other expenses: expenses that are not compensated according to regulations will not be compensated;
9. Continuing medical expenses: In order to close the case in advance, the insured can pay the necessary continuing medical expenses for the injured in the future in advance. Only when the discharge certificate or diagnosis certificate clearly indicates that the competent doctor needs to continue treatment, or the internal fixator is removed after half a year or one year, or the follow-up treatment expenses are reviewed or recorded regularly, and the compensation payment voucher provided by the insurance record for the follow-up expenses can be reviewed. According to the needs of the disease, obviously beyond the needs of the disease, the audit fee for continuing medical treatment will not be compensated.
To sum up, the introduction of medical insurance reimbursement policy can effectively reduce the burden of patients' medical expenses, improve patients' medication and promote patients' better health. At the same time, the medical insurance reimbursement policy can also increase the income of medical institutions and doctors and improve the quality and efficiency of medical services. The implementation effect of medical insurance reimbursement policy is very remarkable, which plays an important role in promoting medical undertakings and patient health protection.
Legal basis:
Article 27 of People's Republic of China (PRC) Social Insurance Law
Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.