Ji'nan will reimburse community out-patient service next month from 300 yuan per year.
Ji'nan times
good news at the Ji'nan city resident medical insurance outpatient conference yesterday: from January 1st next year As a result, the basic medical insurance for urban residents in Ji'nan will increase a new content. The insured will be reimbursed to the designated community clinic. At a cost of more than 50 yuan each time, the outpatient fund is paid by a 50% proportion, and the maximum payment is 300 yuan (excluding the personal payment part) in a medical year. Ji'nan residents' medical insurance recipients must choose a designated community clinic before the end of this month to register to enjoy the "new discount" next year. To help you calculate the account in the community more than 50 yuan can be reimbursed according to the economic people's social hair [2012] No. 164 (No. 164), from next year, the resident medical insurance outpatient will be formally implemented. Those who take part in the urban residents' health insurance can be reimbursed to the designated community out-patient clinic. The medical treatment of the existing insured persons (door rules) and the accidental injury in the outpatient emergency department of the students are not covered by the overall guarantee of the medical insurance outpatient service of the residents, and are still carried out according to the original policy.
urban residents: spend more than 50 yuan, can save half of the money of the citizens of the community a week ago to the community outpatient clinic, taking medicine for a total of about 300 yuan. "Catching a cold and fever at home is much cheaper and more convenient than going to a big hospital." Ms. Zhang said that she had no job and took part in the medical insurance for urban residents. 300 yuan was also a great expense. According to the new regulations, from next year, the outpatient medical expenses of the residents' medical insurance fund will be paid within the coverage of the medical insurance fund, which is more than 50 yuan per time. It is paid by the overall fund of 50%, and the maximum payment limit is 300 yuan (excluding the individual burden) in a medical year. Take Ms. Zhang as an example, she spends 300 yuan in a fixed-point outpatient service, and it only costs 175 yuan in the future: it reduces the starting line of 50 yuan in 300 yuan, and the remaining 250 yuan can reimburse 125 yuan. Economic account: "small diseases and great doctors" does not calculate from January 1st this year, the medical insurance participants in urban residents were hospitalized in the first level medical institutions, the starting and payment lines were 200 yuan, the burden of medical insurance funds for residents was 80%, the individual burden was 20%, and the starting and payment line of the two level medical institutions was 400 yuan, and the burden of the residents' medical insurance fund was 65%, and the individual burden 35% was 35%. The three tier medical institutions pay 700 yuan, the medical insurance fund for residents is 55%, and the personal burden is 45%. The reporter learned from several hospitals that the actual reimbursement would be lower than the above proportion after deducting the contents of the drugs. Also take Ms. Zhang as an example, cost 300 yuan for the treatment of cold, two and three level hospitals can not reach the full payment standard. At the first level hospital treatment requires at least 220 yuan. Therefore, in the future, "minor illnesses and big doctors" are not cost-effective: they can not be reimbursed by the payment line and the fever and so on. On the other hand, from the perspective of social security, professionals believe that this is also a waste of medical resources. College Students: No "start and pay line", the diagnosis fee can be reported to 60% according to the latest regulations, for the insured college students, their medical insurance fund in the outpatient medical expenses within the scope of the residents, the out-patient overall fund in proportion to 60%, in a medical year the maximum payment of 300 yuan (no There is no starting payment standard. At present, the medical insurance of university students is unified by the school. Suppose a student gets a cold and spends 50 yuan in a hospital. He only needs to pay 20 yuan. It is understood that the overall treatment time of the outpatient department according to the medical year calculates a medical year for the insured person from January to December each year. A medical year for the insured students is from September to August of the next year. The benefit range of the newborns can also be organized by the outpatient department at present. There are nearly 1 million people in Ji'nan residents' medical insurance, including about 550 thousand residents and 350 thousand college students. Children and school students in primary and secondary schools are also within the scope of overall outpatient care, which can be selected by parents as a co-ordinate community fixed-point medical institution and put on record in order to enjoy the preferential policy. It is worth reminding the gate and outpatient co-ordination that the outpatient co-ordination will not be enjoyed in the nearly million beneficiary "target population", if not in the designated community clinic before December 31st. It is reported that outpatient co ordination is part of the protection of medical insurance benefits for urban residents in Ji'nan, mainly protecting out-patient medical care for urban residents. As long as the insured persons are normally insured, they can enjoy the corresponding annual outpatient treatment in accordance with the regulations. Outpatient co-ordination only reimbursement for outpatient medical practices in designated community health service institutions where the insured is recorded.
know that the overall planning of the outpatient department is about to be implemented, and Mr. Liu, a citizen, in a reporter's interview, has some doubts: "I have handled the door rules, can we also enjoy the overall planning of the outpatient department?" The Social Security Bureau of the office of the director of the Office introduced, enjoy the resident medical insurance policy of the insured person, also can apply for outpatient provision of medical treatment, "the door rules and outpatient co-ordination does not conflict, the two can participate at the same time."
outpatient department co ordinate do not include the employees of urban staff and workers "our unit to give medical insurance, then I go to the community outpatient registration, will be able to enjoy reimbursement next year?" Ms. Li, the citizen, asked. Relevant people of the Municipal Social Security Bureau replied that many citizens easily confuse medical insurance of urban workers and medical insurance of urban residents, but this is the two different kinds of insurance, the former is mainly undertaken by units, and the amount of reimbursement is often higher than the health insurance of residents. According to the introduction, this new outpatient department does not include medical insurance participants for urban workers, the policy is mainly benefiting from the independent payment, the relative "vulnerable" residents of the insured population.
11 days from December 31st to a designated outpatient registration process, 127 out-patient community designated hospitals received notification, and the record work for the residents of the urban residents has been carried out. The residents of medical insurance need to choose the community in the near future before December 31st, otherwise they will not be able to enjoy the outpatient treatment that is about to start next year.
fixed-point outpatient service can only be selected 1 according to the regulations, the insured can choose the community health service institution of Ji'nan medical insurance in accordance with the actual situation of individual. The insured person himself or agent should hold the resident medical insurance card or identity card before December 31st, and record it in the community designated health service institution. After archival filing, it will be effective for a long time. Next year, if the insured person wants to change the fixed-point community medical institutions for the record, only in the period of the residents' medical insurance payment, the newly selected community should be re handled according to the above filing process. The last record information automatically terminates and produces new record information. It should be noted that only one outpatient clinic can be selected at a time. The settlement needs to show the medical insurance card or to prove that the relevant people of the Municipal Social Security Bureau remind that the insured should be in the normal participation, and pay the corresponding annual resident medical insurance costs in full, and to deal with the overall record of the outpatient service. Otherwise, even if the record is successful, it will not be able to enjoy the overall treatment of out-patient clinic. In the reimbursement link, the insured can use the medical insurance system to deal with the medical settlement with the medical insurance system, only to pay for the individual, and the rest, by the medical insurance department and the fixed-point community. If the insured person has no card for the time being, it can first come to the social security service center of the human resource social security service center to provide an out-patient certification without card, and then pay the individual part only in the selected community health service institution for medical settlement. The policy interpretation of the outpatient department has broadened the resident medical insurance channel and the Social Security Bureau in charge of the office of the Social Security Bureau. It is an important measure to improve the medical security level of the residents. "In the current policy, it broadens the medical security function and reduces the medical cost burden of the insured." The responsible person, from a more macro point of view, as an important part of improving the medical insurance management mechanism, the implementation of out-patient co-ordination is conducive to the overall control of health resources, improve the security performance, and use "economic leverage" to guide the participants "small diseases to the community, big diseases to the hospital." In addition, it is beneficial to support the construction of grass-roots medical institutions, promote the implementation of the basic drug system, promote the coordinated development of the medical and health systems, and coordinate the development of
related residents' medical insurance outpatient service in June 2011. The Ministry of human society issued the general medical insurance outpatient system for urban residents. Suggestions for raising the relevant issues have been put forward. On the basis of guaranteeing the improvement of hospitalization benefits, we should focus on outpatient co-ordination. After the universal medical insurance outpatient Co ordinating program is launched, we will strengthen the assessment of outpatient visits rate and standardize the medical service behavior of the designated medical institutions at the grass-roots level. The designated primary health care institutions shall ensure the use of category a drugs (including essential drugs) in the catalogue of national basic medical insurance drugs, and incorporate them into the assessment system. For the basic medical treatment necessary for some patients, the conditional areas can study and explore the methods of formulating the payment and management of the medicines purchased from the doctor's prescription for the medical institutions of the grass-roots medical institutions. After more than a year of deliberation, the urban residents' outpatient coordination plan in Ji'nan has been officially launched and will be implemented for the first time next year.