Beijing News (Reporter Wu Wei) On May 21, the reporter learned from the Beijing Medical Insurance Bureau that there were major policy changes in the basic medical insurance for urban employees in Beijing. Among them, the high medical expenses of severely ill workers can be "reimbursed", and units and individuals do not pay.
After deducting medical insurance and other payments, medical expenses above 39,525 yuan will enter the "secondary reimbursement"
Recently, the Beijing Municipal Medical Insurance Bureau and the Municipal Finance Bureau jointly issued the "Notice on Further Strengthening the Medical Insurance for Urban Workers" to establish a long-term mechanism for urban employees' medical insurance for serious illnesses, further expand and extend the basic medical insurance system for urban employees, and raise serious and serious diseases. The level of guarantee and the reduction of the burden of high medical expenses for seriously ill workers will be implemented from January 1, 2020.
According to the relevant person in charge of the Beijing Medical Insurance Bureau, after the release of a series of new policies, the triple medical security system for basic medical insurance, critical illness insurance and medical assistance for urban employees and urban and rural residents in Beijing will be further improved.
At present, among the basic medical insurance benefits for urban employees in Beijing, the outpatient reimbursement cap is 20,000 yuan and the inpatient reimbursement cap is 500,000 yuan. After enjoying the basic medical insurance for urban employees in the previous year, the insured employees shall pay the medical expenses by themselves, and after deducting the unit supplementary medical insurance and the medical assistance amount of the social assistance target, the part exceeding the minimum payment standard shall be covered by the urban employee's serious illness medical insurance "Second Reimbursement". The minimum payment standard for 2019 is 39525 yuan.
Persons participating in the basic medical insurance for urban employees in Beijing can be automatically included in the scope of medical insurance for serious illness of urban employees. Units and individuals do not need to pay additional medical insurance premiums.
How much can "secondary reimbursement" reduce the burden of the insured?
For example, the insured employee Lao Wang is seriously ill. The outpatient (emergency) and hospitalization medical expenses incurred in 2019 are reimbursed by the basic medical insurance, and after deducting the unit supplementary medical insurance and the medical assistance amount of the social assistance target, the basic Within the scope of the medical insurance policy, personal medical expenses still have 200,000 yuan.
According to the urban employee serious illness protection regulations, 160,475 yuan above 39,525 yuan will be "reimbursed" by the urban employee medical insurance system for serious illness. Among them, the part within 50,000 yuan will be reimbursed 60%, that is, the fund will pay 30,000 yuan; the part with more than 50,000 yuan will be 110475 yuan, and the second reimbursement will be 70%, that is, the fund will pay 77332.5 yuan; "Reimbursement" can reduce the medical expenses burden of the insured employee by 107332.5 yuan in total.
Serious illness guarantees the integration of urban and rural areas, the same treatment, and the annual settlement
At the same time, Beijing made it clear that the medical insurance for serious illness of urban employees and the insurance for serious illness of urban and rural residents are organically connected, and the treatment is the same.
First, coordinate the adjustment of the minimum payment standard. The payment threshold for urban workers 'serious illness is 1.3 times that of urban and rural residents' serious illness insurance. In 2019, the threshold for urban and rural residents' critical illness insurance is 30,404 yuan, and the urban employee's medical insurance for serious illness is 39,525 yuan.
In addition, the coverage of urban and rural serious illnesses is the same in terms of reimbursement ratio and reimbursement scope. Participants who have paid more than 50,000 yuan (inclusive) for the medical expenses of the insured employees above the standard (excluding) will be paid 60% by the urban employees' large medical mutual assistance funds; individuals exceeding 50,000 yuan (excluding) For self-paying medical expenses, 70% of the large amount of mutual medical assistance funds will be paid by urban employees, and there is no cap.
At the same time, the policy is also inclined towards the poorest groups. For the urban and rural residents in Beijing, the minimum living security personnel, the living difficulties subsidy personnel, the urban and rural low-income relief personnel, the special hardship support personnel and the low-income rural households and other difficult people, the minimum payment standard is reduced by 50%, and the payment proportion of each expense segment is increased by another 5 percentage points, That is, 65% is reimbursed within 50,000 yuan (including), and 75% is reimbursed for the part above 50,000 yuan.
In terms of the settlement process, major medical insurance is settled annually, and the system automatically pays. The urban employees' medical insurance for serious illnesses is settled once a year, and the employer needs to provide supplementary medical insurance for the unit. After deducting the supplementary medical insurance for the unit and the medical assistance amount for the social assistance target, it is automatically credited into the personal account of the insured.
According to the relevant person in charge of the Beijing Medical Insurance Bureau, the medical insurance for serious illness of urban employees in Beijing will be implemented from January 1, 2020. The medical expenses of insured employees in 2019 will be included in the scope of reimbursement of serious medical insurance, reducing the burden of personal medical expenses by 168 million yuan.