Latest｜From next month, Tianjin medical insurance personal account can be "family **** relief"! Method of operation

June 27, from the Tianjin Municipal Government Information Office held a press conference "on the sound employee basic medical insurance outpatient ****ji protection system implementation measures" was informed that the Tianjin health insurance personal account family ****ji function will be formally implemented from July 1st. That is to say, from July 1, 2022, Tianjin officially launched the health insurance personal account family **** Ji function. Employee basic medical insurance participants through the binding of their relatives (spouse, parents, children), can be used to pay the balance of the medical insurance personal account of the above family members in the designated medical institutions in the medical treatment, or in the designated retail pharmacy to buy drugs, medical equipment, medical supplies incurred the cost of the personal burden, and in the future, will also be explored to realize the use of the payment of residents of the medical insurance, long-term care insurance, personal contributions and other functions, to realize the family * * * *. **The company's website has been updated with the latest information on the company's website, including its website.

Gao Lianhuan, deputy director of the Tianjin Municipal Health Insurance Bureau, introduced that for the year 2021, the city's employee health insurance general outpatient medical care 50.77 million times, the health insurance fund paid 8.3 billion yuan. In accordance with the principle of step-by-step implementation, since January 1 this year, the reform of individual account crediting methods, increase outpatient (emergency) clinic maximum payment limit, dynamic adjustment of outpatient (emergency) clinic starting payment standard and other related policies have been implemented. From January to May this year, the city's employee health insurance general outpatient card 21.96 million times, the health insurance fund payment amounted to 4.5 billion yuan. Health insurance personal account family **** relief function will be formally implemented from July 1st. The individual account.

The reform, in accordance with national requirements, the employee health insurance unit contribution part of all into the management of the integrated fund, that is, the unit contribution part of the 0.8% and 1.2% is no longer allocated to the individual account, the individual contribution part of the 2% continue to be allocated to the individual account remains unchanged.

It is important to note that the city's retiree personal accounts are currently implemented in the fixed amount of transfer, in line with the requirements of the national document fixed amount of transfer and transfer standards, not in the scope of this reform. Reform of the individual account crediting method, mainly to consider the enhancement of the integrated fund **** financial function, improve the ability to resist risk, build a solid livelihood "ballast stone".

Second, increase the outpatient (emergency) clinic maximum payment limit

The main focus is to continue to enhance the function of employee health insurance outpatient protection, focusing on the employee health insurance outpatient (emergency) clinic maximum payment limit, from 7,500 yuan before the reform to 9,000 yuan. Among them, the starting line to 5500 yuan (including) part of the payment ratio in the first, second and third-level hospitals, respectively, 75%, 65%, 55%, 5500 yuan to 9000 yuan (including) part of the payment ratio at all levels of hospitals unified 55%.

At the same time, it also improves the pharmacy reimbursement policy, the insured person in the designated retail pharmacy to purchase drugs, in accordance with the relevant reimbursement provisions of the designated medical institutions that issue outpatient prescriptions.

Third, the dynamic adjustment of outpatient (emergency) clinic starting standard

The starting standard for employee health insurance is determined in accordance with the previous year's published average annual salary of 1% of the employees, and moderately skewed towards retirees. This policy, the realization of the employee health insurance starting standard and the level of economic and social development linked to the starting standard will further play the starting standard "the first pass" role in guiding the insured reasonable outpatient consumption. At the same time, it is also conducive to reducing the occurrence of fraudulent insurance behavior.

Fourth, standardize the scope of use of personal accounts

In order to revitalize personal accounts, reduce the depreciation of the fund, approved by the Municipal People's Government, since October 2016, the city will be the employee's own personal account of 70%, injected into the insured employee's own medical insurance card financial account, can be withdrawn for the purchase of commercial insurance and so on. This time, in accordance with the requirements of the national documents, the city's "Implementation Measures" focus on making two aspects of reform arrangements:

First, standardize the use of channels. Employee health insurance personal account is no longer the implementation of capital management, all the implementation of closed management (since January this year, no longer to the financial account for capital injection, has been into the financial account of the part, you can still withdraw cash to use).

Second, the establishment of the **** relief mechanism. Individual accounts can be used for myself and my family (spouse, parents, children) in the designated medical institutions for medical treatment or in the designated retail pharmacy to buy drugs, medical equipment, medical supplies incurred by the individual costs, that is, the individual account part of the realization of the use of my family to use and use of the * * * * * * * * * * * * * *.

The relevant person in charge of the Tianjin Municipal Health Insurance Center introduced the specific use of the health insurance personal account family ****.

Which participants have health insurance personal account

Not all participants have personal account, the city residents health insurance participants are not set up personal account. Whether or not an employee has a personal account depends on the mode of payment adopted by the organization. At present, the city's employee health insurance has two modes of participation and contribution: one is the united account combined mode, the employer in accordance with the contribution base of 10%, the individual in accordance with the proportion of 2%, which is the vast majority of employers to take the mode; the second is the major medical co-ordination mode, the employer or the individual in accordance with the contribution base of 8% of the contribution, which is mainly some of the operating difficulties in the enterprise as well as the individual participation in the mode of contributions taken by the people.

In both models, the insured enjoy the same reimbursement treatment for outpatient (including outpatient special) and inpatient medical expenses, with the same reimbursement amount and proportion. It is important to note that, according to the relevant provisions, only in the unified account combined mode, the insured employees and retirees will establish health insurance personal account, the mode of coordination of major illnesses is not to establish a personal account. According to statistics, as of the end of May, the city's 6.34 million employees health insurance participants, there are individual accounts for 4.86 million people, accounting for 76.6%; not set up individual accounts of 1.48 million people, accounting for 23.4%.

The allocation standard of the individual account of health insurance

After the reform, the individual account of employee health insurance according to different groups, divided into different allocation standards. Among them, the active employees for their own participation in the contribution base of 2%, that is, the individual to pay the full amount of the basic medical insurance, all transferred to the individual account of medical insurance.

Retirees less than 70 years of age, 40 yuan per month, 480 yuan for the year; full 70 years of age, 50 yuan per month, 600 yuan for the year; before the founding of the country to participate in the revolutionary work of the old workers for 60 yuan per month, 720 yuan for the year.

The connotation of the health insurance personal account ****ji

According to the city documents, before the reform, the health insurance personal account is limited to the use of myself in the medical treatment, can not be used between family members ****ji. Since July 1, 2022, Tianjin has formally launched the function of family ****consolidation of individual account of medical insurance. Employee basic medical insurance participants by binding their relatives (spouse, parents, children), can be used for the balance of the individual account of medical insurance to pay for the above family members in the designated medical institutions for medical treatment and diagnosis, or in the designated retail pharmacy to buy drugs, medical equipment, medical consumables incurred a personal burden of the costs, the future will also explore the realization of the use of the payment of residents' medical insurance, long-term care insurance individual contributions and other functions, to realize the family * * * * relief. **Jeep.

How to open the function of health insurance personal account **** Ji

Participants can go to the nearest district health insurance sub-center for on-site processing, but also through the online self-service processing. At present, the online processing mainly supports the following ways:

One is to pay attention to the "Tianjin Medical Insurance Fund Management Center" WeChat public number, in the "handling channels" column select "JinMeiTong

The first is to pay attention to the "Tianjin Medical Insurance Fund Management Center" WeChat public number, in the "handling channels" section, select "JinMediTong"; or directly in WeChat, Alipay search "JinMediTong" small program for;

The second is to download the "JinMediTong" APP for;

The third is to log in the Tianjin medical insurance public **** service platform for. There is also an entrance to the platform on the WeChat public number of "Tianjin Medical Insurance Fund Management Center" ("经办渠道"-"网厅")，which makes it easy for you to It's easy to log in and operate.

After July 1, you can take the above method to open the health insurance personal account **** Jinji function, no processing time limit and other regulations, no need to centralized processing. In addition, after the opening of the function, you can adjust and change the user at any time through the above channels.

If you have any questions about your personal account or other health insurance issues, please feel free to call the Tianjin Health Insurance Service Hotline "12393" for consultation. We will be happy to serve you.

Fifth, the effectiveness of the reform system integration

Based on the **** financial protection system mechanism, play the role of strategic purchase of health insurance, accordingly, to promote the reform of three aspects: First, to support the construction of the primary health care system, to help optimize the allocation of health care resources, convenient for the masses to enjoy the medical services nearby. The second is to promote primary medical institutions to optimize the diagnosis and treatment services for common and chronic diseases, strengthen the management of chronic diseases and implement health management. The third is to improve the payment mechanism compatible with outpatient *** financial protection, to play the role of health insurance payment mechanism leverage, deepen the "three medical" linkage, the overall enhancement of the function of protection.

Sixth, the arrangement of some special measures

In addition, in order to further improve the people's sense of access, the policy also arranged some special measures, such as outpatient co-ordination treatment appropriate tilt to the retirees, to explore the eligible "Internet +" medical services, included in the scope of protection, to further improve the outpatient protection The features of this reform can be summarized as follows The features of this reform are summarized in three aspects:

First, the treatment is more affordable. Through the reform, the employee health insurance outpatient (emergency) clinic maximum payment limit increased significantly by 1500 yuan, reaching 9000 yuan, benefiting the city's more than 6.3 million insured persons, effectively alleviating some of the chronic illnesses insured persons outpatient medical insurance quota is not enough to use the difficult problem; at the same time, the starting outpatient payment standard to the retirement group tilted moderately to further alleviate the burden of seeing a doctor.

Second, the service is more convenient. Through the reform, family members have realized (participants and their spouses, parents, children) **** relief the use of personal accounts. In terms of drug reimbursement, we support the flow of prescriptions, participants to the pharmacy to buy drugs, you can follow the reimbursement policy of the hospital of the flow of prescriptions to enjoy reimbursement, the service experience is further enhanced.

Third, the management is more standardized. Through the reform, the individual account to realize the closed management, the use of the original is limited to the participants to see a doctor, extended to the purchase of medical equipment, consumables and other personal burden of medical expenses, but also **** relief family members to use the use of the scope of use is more and more clearly defined, the management of a more standardized.