Heavy! From next year, Beijing will not set a cap on outpatient benefits for employees, and personal medical insurance accounts will be used for targeted use from September 1.

　　The Beijing Municipal Medical Insurance Bureau issued a message on the 19th. In order to implement the national requirements on the reform of the outpatient mutual economic security mechanism, with the consent of the municipal government, the Municipal Medical Insurance Bureau issued the "Notice on Adjusting the Basic Medical Insurance for Urban Employees in the City" (Beijing Medical Insurance). [2022] No. 28), to further improve the employee medical insurance system, improve the efficiency of the use of funds in individual accounts, and reduce the burden of medical expenses for employees.

The notice makes it clear that

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From next year, there will be no cap line for employee outpatient treatment

For outpatient (emergency) clinics above 20,000 yuan, 60% will be paid

　　At present, the maximum payment limit for outpatient (emergency) medical expenses incurred by the insured personnel of this city's employee medical insurance within a year in line with the city's basic medical insurance payment regulations is 20,000 yuan, and the excess of 20,000 yuan shall be borne by individuals.

From January 1, 2023, the maximum payment limit for employee medical insurance outpatient clinics will no longer be set, and the reimbursement ratio of less than 20,000 yuan will remain unchanged; 60% of the reimbursement for on-the-job employees over 20,000 yuan, and 80% for retirees (including unified supplementary medical care for retirees) insurance), without capping.

It is expected to benefit 170,000 insured persons every year and reduce the burden of insured persons by about 1 billion yuan.

Targeted use of personal accounts from September 1

Funds in personal accounts before September 1 can still be withdrawn freely in the future

　　According to the requirements of the state on the management of basic medical insurance funds, the funds in individual accounts should be used for special purposes.

From September 1, 2022, the personal account funds will be managed by bookkeeping, and the insured personnel cannot freely withdraw them, and realize targeted use. It is mainly used to pay the medical expenses incurred by the insured employees in designated medical institutions or designated retail pharmacies.

The personal account funds that have been transferred to the special passbook for medical insurance before September 1 can still be withdrawn and used by insured personnel at any time in the future.

Improve the level of critical illness insurance

In 2022, the threshold for serious illness of employees will be reduced to 30,404 yuan

　　In order to further reduce the burden of medical expenses for employees with serious illnesses, starting from 2022, the minimum payment standard for serious illness insurance for employees will be reduced from 39,525 yuan to 30,404 yuan.

After the insured enjoys the basic medical insurance for urban employees, the accumulated medical expenses for outpatients and hospitalizations within a year, and the part that exceeds the threshold of payment will be "secondary reimbursement" by the urban employee serious illness medical insurance.

60% will be reimbursed for the portion above the minimum payment standard of 50,000 yuan (i.e., 30,404 yuan to 80,404 yuan), and 70% of the portion above 50,000 yuan (i.e., 80,404 yuan) is reimbursed, and there is no ceiling.

It is expected to benefit 35,000 insured persons every year and reduce the burden of insured persons by 120 million yuan.

Improve the way of crediting personal accounts

The part paid by the unit is all included in the overall fund

　　From September 1, 2022, all basic medical insurance premiums paid by employers will be included in the pooling fund, and all basic medical insurance premiums paid by on-the-job employees will be included in their personal accounts, and the payment ratio will remain unchanged; The quota is allocated, and the current standard is still implemented. Those under 70 years old (excluding) are allocated 100 yuan/month, and those over 70 years old are allocated 110 yuan/month.

From December 1st, personal accounts can be used for family mutual aid

　　From December 1, 2022, spouses, parents, and children who participate in the city's basic medical insurance are allowed to use the funds in the personal accounts of family members to pay for the relevant expenses incurred by themselves and the mutual aid recipients that meet the scope of the use of individual accounts, and You can use your personal account to pay for basic medical insurance and long-term care insurance for urban and rural residents in this city, and purchase supplementary medical insurance in this city (specifically, Beijing Inclusive Health Insurance at this stage) for yourself and mutual aid recipients.

　　Intern reporter Chai Rong