Interpretation of new regulations and latest policies of medical insurance reimbursement in 2023

Attention, everyone in Jiuzhaigou County!

In 2023, the medical insurance policy has been adjusted, and the treatment enjoys more!

Please read on!

First, the new medical insurance policy adjustment in 2023

(1) Improve the overall treatment of outpatient service. In 2022, the top line of reimbursement for general outpatient medical expenses in township hospitals and community service centers will be 25 yuan/person-year, and 45 yuan/person-year will be the second in one year. In 2023, it was adjusted to "the general outpatient medical expenses incurred by insured residents in designated medical institutions at or below the second level, and the top line for reimbursement within one year was 1.50 yuan/person-year, and the reimbursement ratio was 60%, which was settled directly through the Internet." In other words, the outpatient expenses of urban and rural residents in designated medical institutions within the county can be directly reimbursed by swiping their cards. For example, urban and rural residents can reimburse 60% of outpatient expenses for general diseases (except patients with special diseases) in designated hospitals, and the upper limit of reimbursement within one year is 150 yuan/person/year.

(2) payment limit. In 2022, the annual maximum payment limit of the residents' medical insurance pooling fund is 200,000 yuan in the first file and 250,000 yuan in the second file. In 2023, it was adjusted to "the annual payment limit of the residents' medical insurance pooling fund is 250,000 yuan".

(3) hospitalization reimbursement. Set the reimbursement ratio as the reimbursement ratio of the original secondary payment standard, and the tertiary medical institutions in the state will increase by 5 percentage points. For example, Jiuzhaigou County People's Hospital (Grade II) and Zhongzang Hospital (Grade II), the deductible line for hospitalization is 300 yuan, and the reimbursement ratio is 80% of the total fee; Out-of-state tertiary hospitals (Sichuan Provincial People's Hospital, Huaxi Hospital, etc.) inpatient deductible line. ) 900 yuan, the reimbursement rate is 55% of the fee.

kind

content

1 level and below

assistant

Three levels

In-state

Out of state

In-state

Out of state

In-state

Out of state

Deductible line (yuan)

50

150

300

celebrity

600

900

Reimbursement proportion (%)

Eighty-five

65

80

65

70

55

(4) Adjust the reimbursement ratio policies such as referral. Medical institutions at the same level are transferred to hospitals for treatment, and the deductible for the second hospitalization is calculated and adjusted to "For those who have been hospitalized many times during the year, the deductible is gradually reduced by 100 yuan, and the minimum is not lower than that of 50 yuan. If it is transferred to a medical institution at the same level for treatment, the deductible line will be calculated continuously. "

(five) medical records and hospitalization reimbursement. Cancelled the provision that "the hospitalization medical expenses incurred for out-of-state medical treatment without going through the referral and transfer procedures and without filing, will be reduced by 20 percentage points on the basis of the corresponding payment ratio of the corresponding medical institutions".

(six) improve the outpatient special diseases, improve the treatment. First, tuberculosis, multidrug-resistant tuberculosis and severe osteoporosis are classified as chronic diseases, while systemic lupus erythematosus, myasthenia gravis, Wilson's disease, Pueble-Willis syndrome and primary growth hormone deficiency are classified as severe diseases. The second is to improve medical care simultaneously. The annual reimbursement limit for two or more chronic diseases will be raised from 3,000 yuan to 4,000 yuan, and the reimbursement rate for serious and serious diseases will be raised from 70% to 80%.

If it is not insured, please insure it in time.

Don't miss the payment time!

First, the insured payment time

September 22, 2022-65438+February 25, 2022.

Second, the insurance payment method

(1) Intelligent code scanning

Open WeChat → Sweep → Enter the bank smart payment interface. According to the interface prompts, enter your name and ID number, select the basic medical insurance premium for urban and rural residents (note the following figure of Jiuzhaigou County Taxation Bureau), click Next → select normal payment as the payment method, select 2023 as the payment year, and pay by personnel status (for example, ordinary people display 350 yuan). Click the payment base level → click Next to display the amount, and then make payment after confirmation.

(2) Pay attention to the official account of Sichuan Tax WeChat.

Open the WeChat address book, search for "Sichuan Taxation", then pay attention to the official account of Sichuan Taxation WeChat → enter the official account interface of Sichuan Taxation WeChat → pay taxes → pay social security fees → China Construction Bank → continue to visit → enter the name and ID number, select the basic medical insurance for urban and rural residents (Jiuzhaigou County Taxation Bureau is displayed here), click Next → pay by personnel identity (for example, ordinary people display 350 yuan), and click Next to display the amount and confirm.

(3) The mobile phone cannot scan the code to pay.

If you can't scan the code with your mobile phone, you can pay it at the service window of the tax bureau, the service window of the bank or the village (community) Committee where your household registration is located.

Third, the insurance payment standard

(1) In 2023, the individual payment standard of basic medical insurance for urban and rural residents will be 350 yuan/person/year;

(two) poor people, orphans and entitled groups full subsidy;

(3) Individuals identified by the rural revitalization department as unstable poverty-stricken households, marginal poor households, households with sudden severe difficulties, and low-income recipients shall pay RMB/person/year in addition to the fixed subsidy;

(4) The stable poor households identified by the rural revitalization department shall pay 65,438 yuan +0.75 yuan/person/year in addition to the fixed subsidy.

Fourth, please pay attention to the following points.

(1) Deadline for payment: 65438+February 25th, 2022. Please pay on time during this period. If you miss the payment period, you can't pay the fee.

(two) the new insured please go to the township to do new information processing, new residents of the community please go to the medical insurance window of the government center to do new information processing.

(3) Important information such as payment grade, payment amount and payment year must be verified during the payment operation, and the payment grade cannot be changed after the payment is successful;

(four) within 3 months after the birth of a newborn, it must be handled at the medical insurance window of the township or county government affairs center where the household registration is located.

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