Wuxi medical insurance overall qifubiaozhun

Wuxi medical insurance co-ordination Qifubiaozhun refers to the amount of medical expenses that the insured needs to bear before enjoying the medical insurance co-ordination fund payment.

First, the determination of Wuxi medical insurance Qifubiaozhun as a whole

The basis for determining the overall qifubiaozhun of medical insurance in Wuxi is the local economic development level, the medical insurance fund and the actual needs of the insured. Generally speaking, Qifubiaozhun will be adjusted with the increase of medical expenses and the adjustment of medical insurance policies.

Two, the scope of application of Wuxi medical insurance qifubiaozhun.

Wuxi medical insurance qifubiaozhun is applicable to the medical expenses incurred by the insured in designated medical institutions that meet the requirements of medical insurance. These expenses include hospitalization expenses, outpatient expenses for special diseases and outpatient expenses for chronic diseases. The insured must first bear the expenses within the Qifubiaozhun, and the excess shall be paid by the medical insurance pooling fund in accordance with the prescribed proportion.

Three, Wuxi medical insurance Qifubiaozhun payment method

Insured persons can directly settle medical expenses in designated medical institutions through social security cards or medical insurance electronic certificate. At the time of settlement, the medical institution calculates the expenses that should be borne by the individual and the expenses that should be paid by the medical insurance pooling fund according to the insured's medical insurance coverage and Qifubiaozhun, and directly deducts them from the insured's personal account or medical insurance pooling fund.

Four, Wuxi medical insurance Qifubiaozhun adjustment mechanism

With the continuous progress of medical technology and rising medical expenses, the overall qifubiaozhun of medical insurance in Wuxi will be adjusted in due course. The basis of adjustment mainly includes the growth rate of medical expenses, the income and expenditure of medical insurance funds, the affordability of insured persons and other factors. The adjusted Qifubiaozhun will better meet the development needs of the medical insurance system and protect the legitimate rights and interests of the insured.

To sum up:

Wuxi medical insurance co-ordination Qifubiaozhun is an important part of the medical insurance system, and its establishment and application are of great significance for safeguarding the rights and interests of insured persons and rational use of medical insurance funds. Insured personnel need to understand and abide by relevant regulations, arrange medical treatment reasonably, and reduce personal economic burden. At the same time, the medical insurance department should adjust the minimum payment standard according to the actual situation to ensure the fairness and sustainability of the medical insurance system.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28 provides that:

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.

Measures of Wuxi Municipality on Social Medical Insurance

Article 6 provides that:

Social medical insurance in this Municipality includes basic medical insurance for employees, basic medical insurance for urban and rural residents, supplementary medical insurance and social medical assistance. All kinds of social medical insurance in accordance with the provisions of these measures, the implementation of unified coverage, unified financing policy, unified security benefits, unified medical insurance directory, unified fixed-point management, unified fund management.