The city once again increased the reimbursement of health insurance for urban residents

In order to improve the level of basic medical insurance for urban residents and reduce the burden of individual medical care, from August this year, the city has increased the hospitalization reimbursement rate and the maximum payment limit of the basic medical insurance for urban residents, with the reimbursement rate increased by an average of 10%.
 Since the beginning of this year, the city's urban residents' medical insurance coverage has been steadily expanding, and the fund's income has been increasing. As of the end of July, the city's insured residents reached 950,000; all levels of financial subsidies for residents' medical insurance standard from 120 yuan per person per year to 200 yuan. With the increase in the number of insured people and the expansion of the total amount of the fund, the fund's supporting capacity has been increasing, in order to further improve the level of medical protection for urban residents, according to the spirit of the relevant documents of the provincial and municipal governments, it was decided that from August 2011, the reimbursement ratio and the maximum payment limit of the medical insurance fund for urban residents would be increased again. Within one insurance year, the maximum payment limit of the basic medical insurance fund for urban residents was raised to 80,000 yuan for adult residents and 120,000 yuan for minor residents. The reimbursement rates of the fund are calculated in stages according to the categories of personnel and hospital levels, specifically: for adult residents, the reimbursement rates for medical expenses up to RMB 30,000 for hospitalization in designated hospitals of the first-, second-, and third-levels are 65%, 60%, and 55%, respectively, while the reimbursement rates for medical expenses between RMB 30,000 and RMB 80,000 are 70%, 65%, and 60%, respectively. For minor residents, the reimbursement rate of medical expenses for hospitalization in designated hospitals at Level 1, Level 2 and Level 3 is 10% higher than that of adult residents respectively.

 

 

 

 

The city's municipal coordination of employee health insurance is progressing steadily



 Since August 2011, the city's basic medical insurance for urban workers has been integrated at the municipal level in Linqing, Chiping, Dong'a and Guanxian counties on the basis of the city's urban areas, with unified standards for contributions, contribution period and payment of benefits. In order to facilitate the insured workers to see a doctor, enhance the fund's ability to resist risks, and improve the medical insurance treatment, this year will fully realize the urban workers' basic medical insurance municipal coordination, 530,000 insured workers will benefit from it.

County-level co-ordination problems appeared

 It is understood that the city employees' health insurance since October 2000 to start, at that time, due to the county (city, district) between the state of economic development, the level of medical consumption varies greatly, to take the city, county (district) hierarchical co-ordination approach. With the development of medical insurance, the city has gradually established a multi-level medical insurance system, employee health insurance basically realize full coverage, the number of participants more than 530,000 people; medical insurance fund to support the ability to significantly enhance the annual collection of more than 700 million yuan. However, due to the relatively low level of integration, some problems have been exposed. The most prominent is due to the counties (cities, districts) employee health insurance policy is inconsistent, resulting in counties (cities, districts) between the employees to participate in the contributions, enjoy the treatment of differences in the insured employees to compare each other, psychological imbalance. Secondly, the management of the health insurance fund is decentralized, so it cannot play the role of the “law of large numbers”, and its ability to resist risks is relatively poor, resulting in lower health insurance treatment. Thirdly, when insured workers visit designated medical institutions in the city, they need to pay the full amount of medical fees in advance, which causes trouble in reimbursement of medical fees and adds to the financial burden of insured workers.

 Municipal co-ordination to realize “the same treatment in the same city”

 In order to solve the above problems, this year, the city from the people to benefit the people to start, focusing on promoting the work of municipal integration of employee health insurance. Municipal government issued a “Liaocheng City, urban workers basic medical insurance municipal co-ordination of the implementation of the program”, required in accordance with the overall promotion, step-by-step implementation of the approach, the full realization of the basic medical insurance for urban workers in 2011 municipal co-ordination. Human resources and social security departments at city and county levels, as the competent authorities, actively work together with finance, health, audit and other departments to implement the urban-level co-ordination of employees' medical insurance in the municipal, Dongchangfu and development zones from January 1 this year; in August, the municipal-level co-ordination of Linqing, Chiping, Dong'a and Guanxian counties was included in the city-level co-ordination; and the co-ordination is planned to be expanded to cover the whole city by the end of the year. The characteristics of the city's employee health insurance municipal integration, mainly reflected in the “six unified”. First, the unified contribution ratio. Contribution ratio uniform implementation of the employer 7%, 2% of individuals, difficult enterprises and individual workers can be implemented 5% of the ratio; large medical aid payment standard uniform 96 yuan per person per year. Secondly, the contribution period is unified. The insured workers reach the retirement age specified by the state, and the accumulated contribution period for medical insurance is 25 years for men and 20 years for women, after retirement, the individuals do not pay the basic medical insurance premiums, and enjoy the medical insurance treatment for retirees. Third, the unified payment treatment. Individual account transfer ratio, integrated fund payment standards and payment limits are unified in accordance with the relevant provisions of the city. Fourth, unified management services. The city implements a unified management service process and business operation standards, and shares the same computer information network. Fifthly, the settlement of medical treatment within the city is unified. Within the city, medical expenses incurred by insured employees hospitalized in other places will be reimbursed directly through the network in the medical institutions where they reside, and the reimbursement ratio will be the same as that of the same level of medical institutions in the place where they are insured. Sixth, the unified fund management and use. The employees' medical insurance fund implements “budgetary control, hierarchical management, unified collection and expenditure, and citywide transfer”, which enhances the mutual assistance and risk-resistant ability of the fund.

 Benefits for insured workers

 After the implementation of municipal coordination of employee health insurance, the insured employees benefit from various aspects. First of all, the reimbursement treatment has been increased. The maximum payment limit of the medical insurance fund has been raised to 250,000 yuan, and the counties (cities and districts) have raised it from 50,000 yuan to 100,000 yuan compared with the pre-municipal co-ordination period; the reimbursement ratio for hospitalization has also been raised to different degrees. The scope of outpatient chronic diseases has been increased from 11 to 31, and health insurance service programs such as family hospital bed medical care and accidental injury treatment have also been comprehensively carried out in counties (cities and districts), significantly expanding the scope of coverage and benefits. Secondly, the burden of medical care has been reduced. After the implementation of municipal integration, insured workers hospitalized in all medical insurance designated hospitals within the city area, can be “medical insurance card” for medical insurance network hospitalization procedures, medical fees at the time of discharge through the computer network direct settlement, the individual does not need to pay the full amount of the advance, only need to take the self-payment part of the medical fees, the rest of the designated hospitals by the hospital advance payment. This greatly reduces the burden of insured workers in seeking medical treatment and really brings them benefits. Thirdly, it is convenient to see a doctor. Previously, counties (cities and districts) are their own way, health insurance policy is not unified, health insurance contribution base, reimbursement standards are also different, insured workers across the county to see a doctor is very inconvenient, fixed-point medical institutions management is very difficult. After the implementation of municipal coordination, the citywide implementation of a unified health insurance policy not only facilitates the access of insured employees to medical care, but also helps the designated medical institutions to provide efficient medical services.