Nanjing Medical Insurance Management Center

Recently, Ms. Li, who lives in Pukou, was arrested by the police. The first thing you need to do is to take your son to the provincial hospital to see the rhinitis, and when you register, you are ready to brush your health insurance card, and then you are told that the Pukou card can not be brushed in the urban area, and you have to go back and do some formalities. Ms. Li didn't want to go through all that trouble, so she paid out of her own pocket. Like Ms. Li's son such a situation, in Jiangning and other districts also exist. The reporter recently learned from the Nanjing Social Security Center Health Insurance Department, Nanjing has developed a rural and urban residents health insurance merger timetable, as soon as the end of next year, the health insurance city-wide unification, the old five counties New Agricultural Cooperative in the main city of the obstacles to brush the health insurance card will no longer exist.

Nanjing residents health insurance unification has a timetable

Long-term urban residents' health insurance and the new rural cooperation is divided into the management of the two departments of the people's society, health, the system is relatively independent. Previously from January 2016, Nanjing 3.87 million urban workers health insurance has been unified, Gaochun, Lishui July 1 that year and the main city to converge. The remaining 1.71 million residents insured under the New Rural Cooperative still have the problems of inconvenient cross-district medical care and inconsistent payment and reimbursement standards.

Nanjing Municipal Social Security Center health insurance department staff, Gaochun, Lishui, Jiangning, Pukou, Liuhe old five counties, as well as Yuhuatai, Qixia part of the rural residents, participating in the new rural cooperative, not the residents of the health insurance. This part of the residents are mainly the elderly, newborns, children, primary and secondary school students, and college students. Nanjing this year listed the urban and rural residents health insurance merger timetable, is expected by the end of 2018, will realize the whole city health insurance coverage, financing policy, protection treatment, health insurance directory, fixed-point management, fund management? six unified? , eliminating the differences between the same city.

The overall treatment will not be reduced after the merger of medical insurance

In 2017, the Nanjing urban residents' medical insurance did not increase the basis of individual contributions, and then raised the overall standard. Elderly residents 400 yuan per person/year (household registration moved into less than 10 years 900 yuan/year); other residents 480 yuan per person/year (household registration moved into less than 10 years 960 yuan/year); students and children 150 yuan per person/year (including children of migrant workers in the city).

After participating in the resident health insurance, in the enjoyment of treatment: more than 20,000 yuan to 40,000 yuan part, health insurance payment 50%; more than 40,000 yuan to 60,000 yuan part, health insurance payment 55%; more than 60,000 yuan to 80,000 yuan part, health insurance payment 60%; more than 80,000 yuan to 100,000 yuan part, health insurance payment 65%; more than 100,000 yuan part, health insurance payment 70%.

And the new rural cooperative payment standard, Pukou District, for example, in 2017, Pukou District household registration personnel per person per year to pay 260 yuan, students and children per person per year 260 yuan, born after July 1 last year, 130 yuan per year. In addition each person has to pay 40 yuan of supplemental insurance for major diseases. Pukou New Agricultural Cooperative cardholders in the district community health service centers, service stations to see the highest reimbursement rate of 85%, the guaranteed compensation of 35%. If you want to see a doctor in the main city of Nanjing, it is limited to 24 provincial and municipal designated hospitals, and the first hospital in the area for referral, otherwise the reimbursement rate will be reduced.

After the unification of residents' health insurance, there will be no such problem. With a unified Nanjing health insurance card, you can swipe your card at hospitals across the city and enjoy instant reimbursement, rather than going back to your home district for reimbursement. As for the reimbursement rate, the different policy regulations of the Resident's Health Insurance and the New Agricultural Cooperative have led to large differences. The new rural medical insurance hospitalization payment ratio is lower than the residents of the medical insurance, and mainly to the community health center tilt, the overall residents of the medical insurance hospitalization treatment is higher than the new rural medical insurance.

The staff of the Ministry of Health Insurance, health insurance merger, enjoy the treatment tends to be higher not lower. However, still from the perspective of health insurance affordability, to determine the final city's unified standard. In accordance with the requirements of the Nanjing merger, follow the protection of moderate, balanced income and expenditure, the overall treatment of the principle of not lower, do a good job of health insurance treatment policy convergence. Further improve the outpatient policy, the fund payment ratio is in principle not less than 50%. Gradually unify the urban and rural residents health insurance hospitalization medical expenses starting standard, payment ratio, the maximum payment limit, the policy scope of the fund average payment ratio of about 75%.

The foreign medical treatment must be filed before reimbursement

In addition to the urban and rural health insurance to achieve unified network settlement, the foreign medical brush medical insurance card has also affected a large number of people.

Since New Year's Day in 2017, the network settlement of medical treatment in different places in Jiangsu Province has been realized. Nanjing people to visit the field to see a doctor, or foreigners to Nanjing to see a doctor, can be in the local hospital brush medical insurance card instant settlement.

However, in the actual process of seeing a doctor, many people still do not enjoy the convenience of foreign medical treatment because they do not understand the policy. The relevant staff of the Nanjing Municipal Social Security Center Department of Health Insurance, the need to go to the designated hospitals to be able to do so.

Currently, the number of designated hospitals in Nanjing has increased from 10 to 122. In addition, the foreigners to Ningxia medical personnel must hold the local health insurance agency issued by the approval of the foreign medical materials, to the Nanjing City District Street social security card card system outlets to receive the Nanjing City social security card, and in the district, the street social security window to open the foreign medical settlement function, to complete these procedures, in order to really enjoy the benefits of the foreign medical settlement.

Similarly, Nanjing people to foreign hospitals, you need to go to the Nanjing health insurance agency to fill out the application form for medical treatment in a different place, after examination and approval of the social security card card production department to receive the social security card, open the settlement function of a different place before you can.

There is another situation, if the designated hospital in Nanjing for off-site medical treatment, but did not swipe the card or did not realize the network settlement, the cardholder needs to go back to the participating agencies, in accordance with the sporadic reimbursement policy reimbursement. Once you leave Nanjing to go back to your original place of residence, you need to revoke the off-site medical procedures in Nanjing, or else it will affect the medical treatment and reimbursement in the original place of residence.

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