New Rules for Medical Insurance Reimbursement in Beijing in 2023

The new rules for medical insurance reimbursement in Beijing in 2023 are as follows:

Since June 65438+ 10/day, 2023, the maximum payment limit for medical insurance outpatient service for employees is no longer set, and the reimbursement ratio of less than 20,000 yuan remains unchanged; Employees with more than 20,000 yuan will be reimbursed 60%, and retirees will be reimbursed 80% (including unified supplementary medical insurance for retirees). There is no upper limit.

In this adjustment scheme, the proportion of reimbursement for the part below 20,000 yuan will remain unchanged, and the relevant medical insurance reimbursement scheme announced by Beijing on May 1 day in 2020 will continue to be implemented, in which the deductible line for employees is 1800 yuan and the deductible line for retirees is 1300 yuan. Different from before, there is no longer an upper limit of 20,000 yuan, and the reimbursement rate of community hospitals has reached over 90%.

In addition to canceling the ceiling of 20,000 yuan for outpatient reimbursement, the ceiling of serious illness insurance for urban employees has also been adjusted.

It is understood that starting from 2022, the threshold for serious illness insurance for urban employees will be reduced from 39,525 yuan to 30,404 yuan, down by 9 1, 2 1 yuan. After the urban workers and urban and rural residents in this city enjoy the basic medical insurance benefits, the accumulated personal out-of-pocket medical expenses for outpatient and inpatient services exceed the Qifubiaozhun for "secondary reimbursement" within one year, with no ceiling. After exceeding the deductible, the reimbursement rate for less than 50,000 yuan is 60%, and the reimbursement rate for more than 50,000 yuan is 70%.

Medical insurance coverage:

1, drug reimbursement for basic medical insurance

Our country now divides drugs into three categories: A, B and C, among which A drugs are within the scope of medical insurance, so medical insurance can only reimburse A drugs, and B and C drugs cannot be reimbursed;

2. Reimbursement of basic medical service facilities

This reimbursement scope mainly refers to bed fees, first-aid bed fees, consulting fees, etc. Expenses incurred by the insured in the process of diagnosis, treatment and nursing in designated medical insurance institutions;

3, the basic medical insurance treatment project reimbursement

It must be a safe and effective diagnosis and treatment, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.

To sum up, the scope of reimbursement of medical insurance refers to the scope of reimbursement of drugs, diagnosis and treatment management, drug list, diagnosis and treatment items and medical service facilities in order to protect the basic medical needs of the insured.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.