For the insured in Nanjing, before the medical insurance reform, the medical insurance benefits of the local insured were relatively high, but after the medical insurance reform, these benefits have also improved a lot, such as the treatment of outpatient reimbursement, the transfer method of medical insurance personal accounts, and the economic scope of medical insurance personal accounts. In addition, Nanjing has other medical insurance benefits. Next, let's take a concrete look.
First of all, let's take a look at the treatment of medical insurance outpatient reimbursement. From June 65438+1 October1day in 2023, the minimum threshold for outpatient reimbursement of local insured personnel will be cancelled, and reimbursement will be made in stages according to the category of medical treatment and outpatient expenses. Among them, in the case of community medical care, if the outpatient expenses are less than 1000 yuan, the reimbursement ratio is 50%, which is 1000 yuan. For the same outpatient expenses, the reimbursement rates are 40%, 60% and 65% respectively in the case of non-community medical treatment. The higher the outpatient expenses, the higher the reimbursement rate.
Moreover, it should be noted that the maximum payment limit for outpatient reimbursement of local insured personnel has been raised to 1 10,000 yuan.
Secondly, starting from June 5438+1 October1in 2023, the proportion of medical insurance for on-the-job employees will be adjusted to 2% of their own contribution base. Compared with the previous inclusion ratio, after the medical insurance reform, the medical insurance inclusion ratio of on-the-job employees decreased slightly.
2. Impact on retirees
After the medical insurance reform, the outpatient reimbursement of retirees has also been improved, and the maximum payment limit has been raised to 1 10,000 yuan, and the minimum payment standard for outpatient reimbursement has been cancelled, and the reimbursement ratio has also increased a lot. For example, for retirees under the age of 70, the reimbursement rate is 55% in the community, 45% in the non-community and 45% in the community for retirees over the age of 70.
If the outpatient fee 1000 yuan is more than 5,000 yuan, the reimbursement rate of retirees under 70 years old is 80% in the community and 70% in the non-community and 85% in the community and 75% in the non-community for retirees over 70 years old.
The reimbursement rate of retirees from 5000 yuan to 10000 yuan is 85% in community and 75% in non-community; For retirees over 70 years old, the reimbursement rate in the community is 90% and that in the non-community is 80%.
For the old employees before the founding of the People's Republic of China, the reimbursement rate of outpatient expenses above the deductible line is uniform, with the reimbursement rate of 100% in the community and 95% in the non-community. From this perspective, the reimbursement rate of these people is still relatively high.
Secondly, the adjustment of medical insurance transfer and connection methods. For local retirees, from June 5438+1 October1in 2023, the medical insurance transfer amount of retirees: according to the personal account transfer amount in February 65438+2022, and for new retirees in 2023, the medical insurance transfer amount is temporarily based on the pension transfer amount in the month when they retire, after going through retirement procedures. The medical insurance refund will be included on a monthly basis. From June 65438+ 10, 2024, the medical insurance inclusion method for retirees will be adjusted according to the relevant national and provincial regulations.
3, the impact on the insured and retirees * * *.
After the medical insurance reform in Nanjing, in addition to the adjustment of outpatient reimbursement and medical insurance transfer and connection methods, other adjustments have been made to local medical insurance. For example, the insured and retirees can enjoy the following benefits:
The first is to adjust the reimbursement method and reimbursement ratio for special diseases. After the medical insurance reform, 13 kinds of local special diseases have been added, and the reimbursement method has also been adjusted. The restriction that the payment limit is linked to the course of disease has been cancelled, and it has been uniformly adjusted to the highest payment limit for the current disease. For example, the payment limit for malignant tumors is uniformly adjusted to 20,000 yuan per year, and the reimbursement ratio is also uniformly increased. After the medical insurance reform, the proportion of reimbursement for special diseases has been raised to 92%.
Secondly, the adjustment of the economic scope of personal account of medical insurance. The balance of the personal account of medical insurance can be used to pay the expenses of the insured in designated medical institutions, designated retail pharmacies, contracted family doctors, vaccination of non-immune vaccines, nursing insurance for the disabled and health examination. Out-of-pocket expenses incurred when the spouse, parents and children of the insured participate in residents' medical insurance, purchase commercial health supplementary medical insurance and seek medical treatment and medicine can be paid by using the balance of the insured's personal medical insurance account; There are also expenses that can be paid by personal accounts as stipulated by other countries and provinces, and the insured person's medical insurance personal account can be used economically.
Finally, there is a local personal account health incentive mechanism. For the local insured and retirees, if the medical expenses are not reimbursed within one year, the medical insurance refund in the following year can be sent to 200 yuan at one time, and if the medical expenses are not reimbursed for two consecutive years, the medical insurance refund can be sent to 300 yuan at one time. By analogy, the maximum additional amount cannot exceed that of 500 yuan. It should be noted that the medical insurance reimbursement mentioned here only includes sporadic medical expenses reimbursement, excluding outpatient consultation expenses, general medical expenses and nucleic acid testing reimbursement.
4. Wuxi medical insurance reform plan.
Since June 5438+1 October1in 2023, the medical insurance in Wuxi has also been reformed. After the reform, the outpatient expenses of employees and retirees can be reimbursed as long as they reach 500 yuan and 300 yuan. In other words, the minimum payment standards for local employees and retirees were adjusted to 500 yuan and 300 yuan respectively, and the maximum payment limit was raised to 1 10,000 yuan, much higher than the previous 5,000 yuan and 6,000 yuan.
However, it should be noted that the maximum payment limit in designated retail pharmacies and designated outpatient departments is only 2000 yuan per year.
The proportion of medical insurance for on-the-job employees has also been adjusted from the original one-time full payment to monthly payment, and the proportion has also been adjusted to 2% of my payment base. Retirees' medical insurance is temporarily included according to the medical insurance quota in 2022, starting from 2024 1, and the retirees' medical insurance is adjusted to: Wuxi per capita in 2023.
There are also personal medical insurance accounts for local insured and retirees, and their families are also allowed to see a doctor and take medicine. As a result, the medical insurance benefits of the insured and retirees have indeed improved a lot.
To sum up, after the medical insurance reform in Nanjing and Wuxi, the medical insurance benefits of local insured and retirees have indeed improved, and with the adjustment of medical insurance benefits, the impact on insured and retirees is also relatively large, but overall, the impact on us is still relatively good.