Weifang employee medical insurance reimbursement ratio 2023

According to the provisions of the higher level policy, since January 2023, the basic medical insurance personal account of active employees crediting standards: individuals pay 2% into the personal account; the basic medical insurance premiums paid by the unit into the personal account ratio: less than 45 years of age of the incumbent 0.5%, 45 years of age or older (including) 1%.

Simultaneously improving the payment treatment of employees' general outpatient coordination, starting from January 1, 2023, the starting standard for general outpatient expenses within the scope of policy incurred by employees at designated medical institutions of the first (including the first level or below), second and third levels within a medical year is 100 yuan, 500 yuan and 800 yuan respectively, and the reimbursement ratio for the employees is 70%, 60% and 50% respectively, and that of the retired employees The reimbursement rates are 75%, 65% and 55% for active employees and retirees respectively. The maximum payment limit for FY 2023 is $1,600 for active employees and $1,800 for retirees. The annual maximum payment limit is not carried over or accrued to the following year.

Before the official announcement of the list of designated medical institutions for general outpatient services of Weifang Employees' Basic Medical Insurance, insured persons can enjoy the treatment in accordance with the new standard at the original designated medical institutions for general outpatient services that have been contracted.

After the announcement of the new list of designated medical institutions for general outpatient services, the general outpatient services for employees will be provided by the newly included designated medical institutions for general outpatient services. Within a medical year, insured persons can independently choose one of the city's general outpatient fixed-point medical institutions for contracting, with no contracting period, at any time, effective on the next day after contracting; if changes are needed, they can be made at any time, and changes can be made once within a medical year, effective on the next day after the changes are made.

The specific handling process is as follows:

(1) Signing process: Participants can go with their health insurance electronic vouchers or ID cards and social security cards to a general outpatient designated medical institution of their choice for signing and filing, or go to the window of the lobby of the health insurance agency for filing. (2) Change process: Participants can take their health insurance electronic vouchers or ID cards and social security cards to a newly selected general outpatient designated medical institution for change filing, where the newly selected general outpatient designated medical institution will terminate the original contracted information and then maintain the new contracted information, or they can go to the window in the lobby of the health insurance administration organization for change filing. At present, the contracted outpatient system development is underway, can be on-line in the near future, the insured can directly log on the "Weifang health insurance" WeChat public number or Weifang Municipal Bureau of Medical Protection official website for online self-service.

Legal basis:

Social Insurance Law

Article 27 of the basic medical insurance for employees, individuals who have reached the statutory retirement age, the accumulated contributions reached the national provisions of the number of years, after the retirement no longer pay the basic medical insurance premiums, in accordance with the provisions of the State to enjoy the basic medical insurance benefits; has not reached the national provisions of the number of years, you can contribute to the national provisions of the number of years.

Article 28 is in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.

Article 29: The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the enjoyment of basic medical insurance by insured persons.