Proportion of hospitalization reimbursement after medical reform

Here comes the good news again. Recently, Heilongjiang, Hunan, Shaanxi and other places have clearly issued notices to increase the proportion of medical insurance reimbursement.

This also means that people can report more money when they go to the hospital ~

The proportion of medical insurance reimbursement will increase from June 2022 1.

1. Jixi City, Heilongjiang Province: Since June 65438+ 10/in 2022, the proportion of medical insurance reimbursement has increased.

On September 3, 2022, the Information Office of Jixi Municipal Government of Heilongjiang Province held a special press conference on the reform of medical security system. At the meeting, it was made clear that Jixi's basic medical insurance treatment policy will be adjusted from June 2022 10.

These two points deserve our attention:

1, the proportion of local hospitalization reimbursement increased.

The proportion of urban and rural residents' medical insurance reimbursement has increased, and the proportion of urban and rural residents' reimbursement within the hospitalization policy of designated medical institutions in this city has been adjusted to "90% at the first level, 80% at the second level and 65% at the third level".

The proportion of reimbursement for urban workers has increased. The reimbursement rate of on-the-job employees of urban workers within the hospitalization policy of designated medical institutions in this Municipality is adjusted to "90% in first-class hospitals, 87% in second-class hospitals and 85% in third-class hospitals", and the retired employees are correspondingly increased by 2% according to the corresponding hospital level.

2. The proportion of reimbursement for hospitalization in different places has increased.

Unified Qifubiaozhun inside and outside the province. Urban workers and urban and rural residents in different places refer to one person, and the Qifubiaozhun is uniformly adjusted to "inside and outside the province 1000 yuan".

Adjust the proportion of reimbursement for referral hospitalization. The reimbursement ratio in the referral policy for urban and rural residents is uniformly adjusted to "refer to the policies of designated medical institutions at the same level in this Municipality, and the reimbursement ratio is reduced by 10%".

Adjust the reimbursement rate for going out for medical treatment by yourself. The reimbursement ratio of urban and rural residents and urban workers within the scope of the policy of going out for medical treatment by themselves will be uniformly adjusted to "reduce the reimbursement ratio by 20% with reference to the policy of designated hospitals at the same level in this Municipality".

2. Changsha City, Hunan Province: The proportion of medical insurance reimbursement increased by 5%

In July 2022, Changsha Medical Insurance Bureau issued "Several Measures on Medical Insurance Supporting the Inheritance, Innovation and Development of Traditional Chinese Medicine", which was jointly issued by Changsha Medical Insurance Bureau, Finance Bureau and Health and Wellness Committee. Specific measures for medical insurance to support the inheritance, innovation and development of traditional Chinese medicine were formulated from the aspects of total amount tilt, improving treatment, settlement by disease type and classic ward 13.

The notice clearly States:

In terms of improving the medical insurance benefits of urban and rural residents in Chinese medicine hospitals, the insured persons of basic medical insurance for urban and rural residents are hospitalized in municipal and below Chinese medicine hospitals, and the reimbursement rate is increased by 5%. The municipal first-class charging standard medical institutions' hospitalization deductible line is reduced by 200 yuan, and the second-class and third-class charging standards medical institutions' hospitalization deductible line is reduced by 100 yuan.

Third, Xianyang City, Shaanxi Province: Improve medical insurance benefits

Recently, the Xianyang Municipal People's Government issued a document to clearly adjust and improve medical insurance benefits again.

1, reduce the hospitalization deductible standard of first-class and second-class medical institutions.

Medical insurance for urban workers and medical insurance for urban and rural residents will also reduce the deductible line from 220 yuan to 160 yuan, and from 650 yuan to 550 yuan.

2, reduce the proportion of personal payment for class B drugs and special drugs.

Unify medical insurance for urban workers and medical insurance for urban and rural residents, and reduce the proportion of individuals paying more than 5,000 yuan from 25% to 10%.

3. Improve the proportion of hospitalization reimbursement in tertiary medical institutions.

Urban and rural residents' medical insurance co-ordination areas and off-site areas increased by 5 percentage points respectively.

4. Improve the level of outpatient support for "diabetes and hypertension".

The medical insurance for urban and rural residents will be increased from 50% to 60%, and the deductible line for "two diseases" clinics will be cancelled.

Expand the scope of medical insurance reimbursement, and outpatient expenses can also be reimbursed.

In April, 20021year, the General Office of the State Council issued "Guiding Opinions on Establishing and Perfecting the Outpatient Mutual Assistance Guarantee Mechanism for Employees' Basic Medical Insurance", which clearly included outpatient expenses in the scope of medical insurance reimbursement.

At present, local medical insurance bureaus have begun to implement this policy, and the relevant treatment standards are as follows:

Then how can outpatient reimbursement be overstated?

1, go to the designated outpatient hospital.

Just like hospitalization, if you want to reimburse outpatient expenses, you have to go to a designated outpatient clinic for medical treatment. Only outpatient expenses incurred in designated hospitals can be reimbursed by medical insurance.

2. Try to go to a low-grade hospital for minor illnesses.

Because many people go to big hospitals as soon as they get sick, which takes up the medical resources of big hospitals, in order to reduce this phenomenon, the medical insurance policy is also inclined to small hospitals.

The medical insurance treatment in small hospitals is often much better than that in large hospitals, with low deductible and high reimbursement rate.

For example, in Hunan, the first-class hospital has no deductible line, and the reimbursement rate is 70%, while the reimbursement rate is 60% for 300 yuan.

Let's give a simple example to calculate:

Suppose that an outpatient service costs 1000 yuan within the scope of medical insurance.

Medical treatment in community hospitals can be reimbursed 1000*70%=700 yuan.

See a doctor in a 3A hospital, only reimbursement (1000-300)*60%=420 yuan.

Calculated, the same medical expenses, 3A hospitals spend nearly as much as community hospitals in 300 yuan.

So if it's just a minor illness and pain, try to go to a hospital with a lower level, and you can reimburse more!

3. Do a good job in special outpatient treatment.

Specialized outpatient service mainly provides diagnosis and treatment services for patients with chronic diseases and serious diseases. They all have one thing in common, that is, they need to go to a special clinic for a long time to prescribe medicine or treatment, and the cost is not small.

Therefore, the special outpatient reimbursement treatment of medical insurance is very practical and can help patients reduce the cost burden!

If you want to enjoy this treatment, remember to identify the special outpatient treatment first, and you can choose online and offline.

Offline: Take my ID card, social security card, medical records or examination materials to the special window of the designated hospital and fill out the Application Form for Outpatient Treatment and Appraisal of Specific Diseases.

Online: Generally, it can be handled online in local government affairs.