Quadruple positives
The reimbursement treatment of general outpatient services for employees in our city has been upgraded again
In 2024, the city will implement the "Notice of the Anhui Provincial Medical Security Bureau and the Anhui Provincial Department of Finance on Further Optimizing the Outpatient Co-ordination and Security Policy of the Basic Medical Insurance for Employees in Anhui Province", adjust the general outpatient treatment policy of the city's employee medical insurance, further improve the reimbursement treatment, and effectively reduce the burden of ordinary outpatient medical expenses on the insured employees.
The first is to expand the scope. The cost of purchasing drugs in eligible clinics, outpatient departments and pharmacies will be included in the scope of outpatient reimbursement, so as to facilitate employees to purchase drugs nearby and conveniently, and improve the sense of access and satisfaction with the reform.
The second is to lower the threshold. The threshold for reimbursement of outpatient expenses will be reduced from 800 yuan to 400 yuan for secondary and tertiary medical institutions, and further reduced to 200 yuan for primary and ungraded medical institutions, greatly expanding the scope of benefits for the population.
The third is to promote grading. Set up differentiated medical insurance reimbursement policies according to the types of medical institutions, reduce the starting line of primary medical institutions, and increase the reimbursement ratio. The starting line for first-level and ungraded designated medical institutions is 200 yuan, and the reimbursement ratio is 60% for in-service and 70% for retirement, while the minimum payment line for second-level and third-level designated medical institutions is 400 yuan, and the reimbursement ratio is 50% for in-service and 60% for retirement. Through policy levers, minor and common diseases are guided to be diagnosed and treated in primary medical institutions.
Fourth, Hui Yinfa. To implement the requirements of the National Health Insurance Bureau for the preferential protection of retirees, the reimbursement ratio of retirees is 10 percentage points higher than that of in-service employees, and the reimbursement ratio of medical institutions and pharmacies at the first level and below reaches 70%, and the annual payment limit is increased by 1,000 yuan to 3,000 yuan. Employees can get better protection when they are old and sick.
From January to March 2024, Huainan City opened 1,156 designated medical institutions for overall reimbursement of general outpatient clinics for employees, an increase of 878 compared with the same period in 2023, and 238 designated retail pharmacies, an increase of 238 year-on-year. There were 238 medical institutions that were settled, an increase of 80 year-on-year, the settlement volume reached 116254, an increase of 93,026 person-times year-on-year, and the settlement amount was 12.8469 million yuan, an increase of 8.481782 million yuan year-on-year. There will be 1 pharmacy in the settlement, an increase of 1 compared with the same period in 2023, the settlement volume will reach 2, an increase of 2 person-times year-on-year, and the settlement amount will be 0.0876 million yuan, an increase of 0.0876 million yuan year-on-year.
Source: Huainan Medical Security Bureau
(ID:huanfabu)