Where does the money go after Beijing medical insurance reform

According to the provisions of the document of Beijing Medical Insurance Development [2022] No. 28, since September 1, 2022, Beijing has adjusted the relevant policies of basic medical insurance for urban workers, and one of the biggest changes is that the funds in the personal account of Beijing workers' medical insurance will not be able to withdraw cash for use.

First, about the Beijing workers medical insurance personal account can withdraw cash is how?

The Beijing municipal government's policy on individual accounts is slightly different from that of other regions, and the main difference is that the Beijing municipal government's individual accounts can be used for cash withdrawals.

The other regions can only be used to purchase medicines at designated medical institutions or designated retail pharmacies, and to purchase out-of-pocket medicines, medical equipment, and medical consumables that are not covered by the medical insurance.

Before the Beijing employee health insurance reform, that is, since October 2016, Beijing in order to revitalize the personal account to reduce the pressure of fund depreciation, Beijing will be transferred to the health insurance personal account funds of 70%, directly allocated to the employee's personal social security card financial account.

And the financial account of the social security card for individuals, in fact, is a bank card, this part of the funds can be used to withdraw cash and buy commercial insurance.

As a simple example, if an active employee pays $10,000 per month in accordance with the contribution base, to participate in social insurance and pay in full, corresponding to the employee's personal health care account for 10,000 times 2% = 200 yuan, which is credited to the employee's personal health care account of 70%, directly to the employee's personal bank card that is 140 yuan.

After this reform, that is, September 1, 2022 onwards, the Beijing employee health insurance personal account funds will no longer be credited to the individual financial account, but only into the individual health insurance account, can only be used for medical use.

It should be noted that before September 1, 2022, the health insurance personal account has been allocated to the personal financial account of the funds, can still be normal cash.

Secondly, before the reform of the employee health insurance personal account funds can only be used for my use in medical treatment, for many young people, personal health insurance account funds accumulated more, family members can not be used more unfortunately.

Since December 1, 2022, participating in the employee health insurance personal health insurance account funds, can be used between family members ****, that is, **** the same use, but limited to the spouse, parents, children, the relevant costs in line with the scope of use of the personal account.

At the same time, it is important to note that the spouse, parents, and children of the insured person should be insured by the city's basic medical insurance, which means that the ****jewels should be in the same coordinated area.

Third, from 2022 onwards, the starting standard for urban workers' major medical insurance and the starting standard for urban and rural residents' major medical insurance will be lowered from 39,525 yuan to 30,404 yuan.

For example, if an individual employee is hospitalized for a disease, and the hospitalization medical fee*** costs 50,000 yuan, then the starting standard to the part that exceeds the starting standard of 50,000 yuan or less, that is, the part that exceeds 30,404 yuan totaling 19,596 yuan can be reimbursed up to 60%.

And if an individual employee is hospitalized for an illness, and the hospitalization medical expenses*** cost $100,000, the maximum reimbursement is 60% for the portion of the starting standard above $30,404 and up to $50,000 above the starting standard, i.e., the hospitalization expenses of $30,404 to $80,404 totaling $50,000.

And the part that exceeds the starting standard of 50,000 yuan and above, that is, the cost of 80,404 yuan or more part of the total of 19,596 yuan, the maximum reimbursement can be 70%.

Fourth, from 2023 onwards, participants in the employee health insurance, a natural year, for outpatient (emergency) medical expenses in line with the provisions of the basic medical insurance payment, in the maximum payment limit of 20,000 yuan or more, by the large medical expenses of mutual aid funds to pay for 60%, not capped.

That is to say, since 2023, the Beijing Municipality to participate in the employee health insurance individual, if the outpatient costs to reach the outpatient reimbursement of health insurance cap line 20,000 yuan, can still be reimbursed.

Although there is no explicit provision to cancel the outpatient reimbursement payment limit, for those who participate in the employee health insurance, it can be regarded as canceling the outpatient reimbursement payment limit of the health insurance.

Because whether it is paid by the medical insurance, or the large medical expenses mutual funds, for the people, these do not seem to be so important, as long as they can be reimbursed on the line.