New Policy of Medical Insurance for Employees in Hebei Province in 2023

The new policies of medical insurance for employees in Hebei Province in 2023 are as follows:

1. Reform the bookkeeping method of personal accounts. Before the reform, individual contributions and some unit contributions were all included in individual accounts. After the reform, although the funds entering the personal account have decreased, on the whole, the advantages outweigh the disadvantages for the insured;

2. Personal account funds help the whole family. Medical insurance personal account funds can only be used to pay for medical treatment and medicines, and cash cannot be withdrawn for consumption;

3. Outpatient expenses can be reimbursed. In the past, whether participating in employee medical insurance or urban and rural residents' medical insurance, the medical insurance reimbursement policy in Hebei Province was limited to hospitalization reimbursement, and all the expenses incurred by outpatient treatment were borne by patients, which increased the pressure on low-income groups to see a doctor;

4. Enable the new medical insurance drug list;

5. Inter-provincial settlement of hospitalization and outpatient expenses. In the past, there were fatal defects such as heavy prepayment pressure, tired running errands, complicated procedures, long reimbursement period and heavy personal burden in settlement of medical treatment in different places. In the future, after the insured person goes through the formalities of medical treatment in different places, he does not need to advance the medical expenses himself, and then returns to the insured place for reimbursement with various bills. They can directly use the social security card to settle accounts in the outpatient department, and only need to pay personal fees, which is very convenient, fast and efficient.

6. The inter-provincial medical filing procedures are simple, and the registration filing management system is implemented for direct settlement of hospitalization in different places, and the filing procedures are gradually developed from offline to online.

Medical insurance reimbursement process:

1. Under normal circumstances, when you need to be hospitalized due to illness, you can go to your designated hospital with your medical insurance card and medical records, and settle with your medical insurance card. That is, some of them are paid by themselves, and some medical insurance centers and hospitals reimburse and settle accounts;

2 from designated hospitals to secondary or tertiary hospitals, medical insurance cards can be used for settlement;

3. The patient is critically ill and hospitalized in a non-designated hospital. He should go to the municipal medical insurance center for emergency rescue disease identification within 5 days. After being identified as an emergency rescue disease, he can use the medical insurance card for settlement in the rescue hospital;

4, transferred to other places for treatment, with the consent of the hospital and medical insurance center, the referral procedures. The expenses incurred in the field shall be settled by the individual at his own expense, and after the diagnosis and treatment, the community labor security workstation shall prepare the materials for reimbursement;

5, medical insurance reimbursement is calculated in proportion, generally ranging from 70%. The proportion and amount of reimbursement are related to factors such as self-examination, medication and medical grade;

6. At the time of reimbursement, the insured person needs to prepare relevant materials for hospitalization, such as outpatient medical records, discharge records, discharge diagnosis (disease diagnosis), hospitalization invoices (which can be reported to the outpatient department), general list of hospitalization expenses, and medical insurance statements. If the hospital has done CT, B-ultrasound, electrocardiogram and other inspections, it is also necessary to prepare relevant inspection reports;

7, discharge settlement, submit relevant information, in the medical insurance reimbursement window can be reimbursed. After approval, the reimbursement amount will generally arrive within 15 working days.

To sum up, after the insured employees (including flexible employees) reach the statutory retirement age and go through the retirement formalities of endowment insurance, the cumulative payment period of basic medical insurance (including deemed payment period and actual payment period) is 30 years for men and 25 years for women, and the minimum actual payment period of provincial basic medical insurance is 10 year. After handling the medical insurance retirement procedures, you can enjoy the basic medical insurance benefits for retirees.

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.