On October 28, a reporter from Red Star News learned from the Chengdu Medical Insurance Bureau that recently, Chengdu issued the "Implementation Rules for Establishing and Improving the Outpatient Mutual Aid Guarantee Mechanism for Basic Medical Insurance in Chengdu" (Chengbangui [2022] No. 4) (referred to as the "Implementation Rules"), which clearly stated that from January 1, 2023, the general outpatient costs of employees insured in Chengdu will be included in the payment scope of the employee medical insurance unified fund, reform the employee medical insurance personal accounts, establish and improve the outpatient Mutual Aid Guarantee Mechanism, improve the efficiency of the use of medical insurance funds, gradually reduce the medical expenses burden of insured personnel, and achieve a more fair and sustainable medical insurance system.
The Implementation Rules clearly state that the method of accounting for personal accounts is improved, and all basic medical insurance fees paid by the unit are included in coordinated fund . The basic medical insurance premium paid by the individual account of an incumbent employee is included in the basic medical insurance premium payment base, and the accounting standard is 2% of the insurance premium base. The personal accounts of retirees are transferred by the unified fund according to the fixed quota. The transfer base of personal accounts is the average level of basic pension in Chengdu in 2022, with an entry ratio of 2.8%. Insured persons participating in the single-built coordination will not establish personal accounts.
The Implementation Rules propose to establish a general outpatient expenses coordinated and guarantee system, and the general outpatient expenses coordinated and guarantee system covers all employees insured in Chengdu’s employees’ medical insurance. Insured persons who meet the conditions for employee medical insurance benefits shall be included in the general outpatient expenses and drug purchase expenses within the policy scope of the designated medical institution for and designated retail pharmacies that meet the conditions. deductible is set once in the natural year and calculated in a cumulative amount within one natural year. The deductible quota for employees is 200 yuan and the deductible for retirees is 150 yuan.
The medical expenses incurred by insured persons at level 3 designated medical institutions and qualified designated retail pharmacies are 50%, and the payment ratio of second-level and below designated medical institutions is 60%. Retired persons increase by 10 percentage points based on the above corresponding payment ratio. The medical expenses for employees participating in the unified account combined with are the annual payment limit for the unified fund and 2,500 yuan for retirees; the medical expenses for employees participating in the single-built coordination are 880 yuan for the unified fund and 1,100 yuan for retirees.
The Implementation Rules also stipulate that it is necessary to establish outpatient medication guarantee for hypertension and diabetes ("two diseases"), improve the outpatient special disease protection function, clarify outpatient mutual assistance protection methods, and strengthen management and supervision.
Red Star News Reporter Peng Jing
Editor Chen Yixi
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