On the job workers pay 14 yuan per month for outpatients to see that a cold can also be reimbursed.
Shandong Commercial Daily
Social Insurance Department detailed explanation of staff health insurance policy adjustment today is the last day of consultation on the adjustment of medical insurance policy for workers in Ji'nan . Yesterday, Jinan City People's social Bureau explained in detail the background of this policy adjustment, and the changes that the new policy could bring to the insured workers in the future. It is reported that after the implementation of the new policy, the personal account of employees on the job will pay more than 14 yuan a month, but it will also enjoy the overall planning of the outpatient service. After that, even in the outpatient, a cold can be reimbursed. Reporter Liu Jianyu
[policy background]
the implementation of the outpatient department of the outpatient department can reduce the length of the team of large hospitals
this time the medical insurance of the staff and workers is to be implemented as a whole, because in the past 12 years, the situation of the insured workers to the hospital is "unified account combination", that is to say, the hospitalization expenses of the insured are in government. The policy is reimbursed, while the average outpatient medical expenses are not reimbursed by the individual, which virtually increases the burden of medical treatment for ordinary workers.
although in order to prevent the overburden of chronic patients in some outpatients, Ji'nan has the policy of "outpatient prescribed disease" into the overall plan, but the policy of the door rules is mainly to protect the disease and serious illness. Insured people "squeeze door rules", resulting in large hospitals get together and queue up.
[policy content]
a year of outpatient service can be reported to 2400 yuan
the main content of the overall policy of the outpatient department of Ji'nan, including three aspects: first, fund raising. The overall fund of the outpatient department is shared by the overall fund and personal contribution, and the individual contribution is partly to be raised according to the standard of 10 yuan per person per person per month. At the same time, the standard of the large amount of medical aid payment is raised from 4 yuan to 8 yuan per month. The two is the starting and paying line. In a medical year, the starting and payment lines of the three level designated medical institutions of the city were 1200 yuan, 700 yuan at the two level and first level designated medical institutions and 400 yuan for the designated community health service institutions. Three is the policy of reimbursement. The maximum payment limit was 2400 yuan during the year, of which 1600 yuan was reimbursed by the co-ordination fund and 800 yuan was reimbursed by the large medical grant.
[policy background]
why to cancel 12 gage diseases
because of the adjustment of the health insurance policy of the workers, it is a problem that the residents are most concerned about. The reporter learned that after the implementation of the outpatient service, there are two forms of protection in the treatment of medical insurance outpatient service in Ji'nan City, which are "door rules" and "outpatient co-ordination". From the future function division, it is mainly to solve the "small disease" problems such as common diseases and multiple diseases through the overall planning of the outpatient department, and to solve some special diseases and "heavy" through the door rules. The problem of disease. To this end, Ji'nan will be a relatively low cost, can be cured and can basically meet the needs of the outpatient department of type IV diseases and ophthalmological diseases into the general out-patient overall planning, the insured people do not need to be identified, that is, in accordance with the policy of out-patient co-ordination to enjoy treatment.
[policy content]
hyperthyroidism and
according to the content of consultation, the city of Ji'nan is to cancel 12 types of disease, namely, chorea, chronic bronchitis, hyperthyroidism, gout, osteoarthritis (hand, hip, knee osteoarthritis), brain atrophy, Hypothyroidism (primary), lithiasis (urinary system, digestive system), digestive system diseases (superficial gastritis, atrophic gastritis, gastric ulcer, duodenal ulcer), intervertebral disc herniation, femoral head necrosis, ophthalmologic disease (macular hole, optic atrophy, glaucoma).
[policy background]
three level reimbursement ratio encourages the public community to visit
after the implementation of the outpatient service, the reporter noticed that the proportion of the out-patient co-ordinate reimbursement in different hospitals is also different, among which the three level hospitals are the lowest. Because outpatient diseases are mostly common diseases and frequently occurring diseases, the general community clinic can meet the needs. As far as field practice is concerned, the scope of the implementation of outpatient co-ordination is also implemented in the community medical institutions and not in the three level hospitals. But considering the medical habits of the participants in Ji'nan, the city's three level hospital has been retained in the consultation, but the relative rise and payment standards are high and the proportion of reimbursement is low. Through the policy lever, the country's requirements to the grass-roots level are reflected, and the participants are guided to "the small diseases into the community, and the great diseases should enter the hospital according to the need."
[policy content]
community medical service reimbursement can reach 60%
this policy adjustment, which is mainly applicable to the insured personnel involved in the municipal level of workers' medical insurance, including the city level, the calendar District, the Central District, the Huaiyin District, the Tianqiao District, the almanac District, the high and new zone, the Changqing district staff medical insurance The insured person. After the
medical insurance policy adjustment, the city's three, two and first grade and designated community health service agencies reimbursed 35%, 55% and 60% respectively. The three tier medical institutions in the city are 20 percentage points lower than those in the two level institutions.
> [policy background]
why retired staff and employees to cover the top
to cover the personal account of the retired employees, the amount of the cap is mainly referred to the provincial standard, but the amount of the individual account has already exceeded the top line when the policy is implemented, and the original amount will remain unchanged. The two is the "10 yuan" outpatient fund and 8 yuan large medical subsidy, which should be deducted from the account. And the bottom seal is divided according to age. From the long term, it will gradually transition to a fixed amount into individual accounts according to the age section, and ultimately the personal account is delimited with the pension, which is more in line with the principle of "two distribution pay attention to fairness".
in the long run, this will also help to narrow the gap between the vulnerable groups after retirement and the higher income groups.
[policy content]
retirement account does not need to pay
the retiree medical insurance personal account without its own payment, according to the age section is not higher than the basic pension (pension) of 4%, the implementation of the bottom seal. Among them, the account amount under the age of 60 is below 50 yuan by 50 yuan, the maximum not exceeding 170 yuan 60 years to 70 years (excluding) the monthly account amount is lower than 60 yuan under 60 yuan, the maximum is not more than 190 yuan; 70 years to 80 years (excluding) the monthly account amount is lower than 70 yuan below $70, maximum not more than $50 Year (excluding) the monthly (excluding) the monthly account amount of less than 80 yuan is 80 yuan, the maximum is not more than 220 yuan; 90 years and above the monthly account amount less than 90 yuan under 90 yuan, the maximum not more than 220 yuan.