Recently, Xiaoyi has received a lot of questions from friends asking about medical insurance reimbursement.
Recently, there is good news about medical insurance reimbursement again! Let Xiaoyi tell you the good news!
People’s Daily Health Client News, starting from July 1, these expenses will be reimbursed by medical insurance!
People's Daily Health Client found that recently, Anhui, Hebei, Yantai, Shandong, Dalian, Liaoning, and other places have issued policies to expand the scope of payment for some medical services and medical consumables, which involves medical insurance payment for day ward treatment and dental care. Medical insurance payment for medical service items, medical insurance payment for medical consumables, etc. Friends in these cities should pay attention~
01 Dalian, Liaoning: Medical insurance can also reimburse for day ward treatment
"From July 1, 29 types of day surgery, 20 types of day chemotherapy regimens and 23 types of day high "Value drug injection treatment is included in Dalian medical insurance payment management, and patients treated in day wards can also be reimbursed by medical insurance." On June 30, the Dalian Municipal People's Government Information Office held a press release on Dalian's pilot reform of medical insurance payment for day ward treatment. will be mentioned.
Patients are treated during the day and go home at night, which not only reduces the burden of medical treatment, but also eliminates the inconvenience of the patients' family members accompanying them.
According to the "Notice on Carrying out the Pilot Program of Medical Insurance Payment Reform for Day Ward Treatment" issued by Dalian Medical Security Bureau , day surgery diseases involve inguinal hernia repair, colon polyps and rectal polyps resection. 29 types of ambulatory surgery, including lithotripsy for ureteral stones and phacoemulsification of senile cataract with intraocular lens implantation. 20 daytime chemotherapy regimens for breast cancer , lung cancer, intestinal cancer , gastric cancer and esophageal cancer 5 common malignant tumors are refined. The necessary inspection and disposal costs for 23 high-value drugs that need to be used via intravenous, intrathecal and other administration routes, including cetuximab (injection) and nosinaxin sodium (injection), are included in the daily The scope of medical insurance reimbursement for each ward.
Ma Dan, deputy director of the Medical Services Department of Dalian Municipal Medical Security Bureau, pointed out: " Dalian Municipal Insured persons in day wards have day surgeries that are within the scope of the disease category, and the deductible standards (i.e. threshold fees) and medical insurance The reimbursement ratio is based on the hospitalization policy for various types of personnel. Among them, there are no minimum payment standards for day-time chemotherapy and day-time high-value drug injection treatment for senile cataract intraocular lens implantation and intravitreal drug injection for macular degeneration. There is no minimum payment standard (that is, there is no threshold fee). Among them, daytime high-value drug expenses are reimbursed according to the province's unified high-value drug payment policy, and the medical service items involved in daytime high-value drug injection treatment and daytime chemotherapy medical expenses are reimbursed according to the province's unified high-value drug payment policy. Implementation is based on the hospitalization reimbursement ratio for various types of personnel. "
Anhui Province: 15 oral medical service items are included in the medical insurance
" 15 oral medical services including tooth desensitization treatment, fluoride anti-caries treatment, scaling, and local oral irrigation and medication. New service items have been included in the payment scope of Anhui Province's medical insurance. "Anhui Province has issued the "Notice on the Inclusion of Some Dental Medical Service Items in the Payment Scope of Medical Insurance and Work Injury Insurance", which will be implemented from July 1, 2022, and Anhui Province will include it. The number of dental medical service items reimbursed by medical insurance will increase to 293.
In the next step, the Anhui Provincial Medical Insurance Bureau will gradually reduce the burden of patients’ dental medical expenses by implementing the province’s unified employee medical insurance outpatient mutual aid insurance policy, participating in centralized procurement to reduce the prices of some high-value dental medical consumables, and other measures.
Hebei Province: 50 medical service items and 242 types of medical consumables are included in the payment scope of medical insurance
"50 medical service items and 242 types of medical consumables are included in the payment scope of medical insurance and are managed according to Category B." June 28, Hebei The Provincial Medical Insurance Bureau’s website issued the “Notice on Carrying out a Pilot Program at the Provincial Level to Incorporate Some Medical Services and Medical Consumables into the Scope of Medical Insurance Payment”, which will be implemented from July 1 and the pilot period will be six months.
People's Daily Health Client found that the 50 pilot medical projects involve magnetic resonance heart function examination, artificial liver treatment, deep brain electrode implantation, thyroid peroxidase antibody measurement, etc.
Based on the implementation of the policies and price limits of the "Hebei Province Basic Medical Insurance Diagnosis and Treatment Items and Medical Service Facilities Catalog" and the "Hebei Province Chargeable Disposable Items Management Catalog (2021 Edition)", "Category A" diagnosis and treatment items and consumables are not Set an individual first self-payment ratio , which will be paid by the basic medical insurance co-ordination fund in accordance with regulations; for "Category B" diagnosis and treatment items and consumables, the insured person will pay 10% first, and those who participate in civil servant subsidies (or 10% supplement) will pay first The self-pay part is not personally borne; "Category C" or "self-pay" medical treatment items and consumables are all borne by the insured person personally.
Yantai, Shandong: Employees can be reimbursed for general outpatient medical treatment
"Starting from July 1 this year, Yantai City will launch the implementation of the employee medical insurance general outpatient co-ordination system, and include outpatient expenses in the payment scope of the employee medical insurance co-ordination fund to reduce outpatient medical treatment for insured persons. Cost burden." On June 29, the Yantai Municipal Medical Insurance Bureau issued a notice on its website.
The notice points out that the ordinary outpatient medical expenses incurred by the insured at the designated medical institutions of the Yantai Employees' Medical Insurance General Outpatient Clinic are in compliance with the medical insurance policy (general outpatient medical expenses incurred by the insured employees in compliance with the national medical insurance drug catalog, diagnosis and treatment item catalog and service facility catalog expenses) are included in medical insurance reimbursement.
In a calendar year, the minimum payment standard for designated medical institutions at the first level and below is 500 yuan, and the minimum payment standard for designated medical institutions at the second and third levels is 800 yuan. If the insured person changes designated medical institutions within the year, the cumulative minimum payment standard shall not exceed 800 yuan.
The reimbursement rate for active employees in designated medical institutions at the first level and below is 70%, the reimbursement rate at the second-level designated medical institutions is 60%, and the reimbursement rate at the third-level designated medical institutions is 50%. The reimbursement rate for retirees is 5 percentage points higher than that for active employees.
In a calendar year, the maximum reimbursement limit for ordinary outpatient medical expenses for active employees and retirees is 1,800 yuan, and it will be 900 yuan in 2022.
