It will be more convenient for the flow of people and the employment of workers to cancel the household registration restrictions for insurance in our city; At the same time, further reduce the burden on enterprises and various employers and optimize the business environment in our city. The payment of basic medical insurance for employees of the employing unit is adjusted to 6.5% according to the proportion of 7.5% of the payment base of the unit. By reducing the proportion of contributions, it is estimated that the burden of insured enterprises and units can be reduced by 368 million yuan each year.
Adjust the basic medical insurance and maternity insurance benefits for employees;
1 Increase the payment limit of basic medical insurance for employees. The maximum payment limit of the employee's basic medical insurance pooling fund will be raised from 6.5438+0.2 million yuan per person per year to 6.5438+0.5 million yuan.
2. Reduce the hospitalization deductible line of the first-and second-level designated medical institutions. The first-level designated medical institutions hospitalization deductible line was adjusted from 600 yuan to 400 yuan, and the second-level designated medical institutions hospitalization deductible line was adjusted from 700 yuan to 600 yuan.
3. Adjust the treatment of inpatients with malignant tumor. In the past, inpatients with malignant tumors used radiotherapy and chemotherapy drugs when they were hospitalized, and they were charged according to the natural annual one-time Qifubiaozhun, which was adjusted to the natural annual one-time Qifubiaozhun when they were hospitalized for malignant tumors in this city. Solve the restrictive clauses of the use of chemotherapy drugs in the past, and further reduce the burden of patients with malignant tumors.
4. Improve the cost standard of prenatal examination in designated medical institutions below level 3. The quota settlement standard for female employees in first-class and second-class designated hospitals was raised from 800 yuan to 1000 yuan. Prenatal examination expenses and production expenses shall be paid together at the time of discharge settlement.
Adjustment of employee's serious illness insurance benefits;
1 Increase the reimbursement rate. This time, it is clear that the compliant medical expenses for employees' hospitalization (including outpatient special diseases) above the maximum payment limit of basic medical insurance and within the maximum payment limit of major illness insurance will be paid by "subsection calculation". The specific proportion is: 90% for less than 6,543,800 yuan, 92% for 6,543,800 yuan (inclusive) to 200,000 yuan (inclusive) and 95% for more than 200,000 yuan. Break the previous 90% fixed reimbursement ratio.
2 increase the payment limit. The maximum annual payment limit of the employee's serious illness insurance fund has been raised from 400,000 yuan per person per year to 500,000 yuan, and the ability of serious illness insurance to "protect serious illness" has been continuously enhanced.
Personal account reform and treatment adjustment of employees
1 Adjust the personal account transfer standard. The proportion of individual accounts is divided into age groups, adjusted to 2% of the base of my insurance payment, and all the basic medical insurance premiums paid by the unit are included in the overall fund; After the medical insurance retires, the individual account is allocated by the overall fund on a monthly basis, and the amount allocated is 2%+0 of the monthly average basic pension of the insured retired workers in our city in 20265438.
2. Expand the scope of personal account payment. Establish employee personal accounts and help each other's families. Employee personal accounts can be used to pay the medical expenses incurred by the insured and their spouses, parents and children in designated medical institutions, as well as the expenses incurred by individuals in purchasing medicines, medical devices and medical consumables in designated retail pharmacies.
3. Improve the level of general outpatient treatment. The deductible line for outpatient service of employees was reduced from 300 yuan to 100 yuan, the reimbursement ratio was increased from 30% to 50%, the retired employees were increased to 60%, and the payment limit was increased from 1200 yuan to 2,000 yuan.
4 outpatient chronic special diseases and general outpatient treatment at the same time. In the past, you can only choose the treatment of chronic diseases and special diseases in general outpatient service and outpatient service of insured workers, and you can enjoy the treatment of chronic diseases and special diseases in both general outpatient service and outpatient service.
Policy adjustment of medical insurance system for urban and rural residents
The basic medical insurance for urban and rural residents will include all urban and rural residents who have not participated in employee medical insurance in our city according to the requirements of household registration system reform. Cancel the restriction that urban and rural residents outside the overall planning area need a residence permit to participate in insurance in our city, as long as they hold their ID cards and household registration books. The adjustment of major illness insurance benefits for urban and rural residents focuses on vulnerable groups, and the protection for vulnerable groups is strengthened. The minimum threshold for serious illness insurance will be reduced by 50%, the payment ratio will be increased by 5 percentage points, and the maximum payment limit will be cancelled.
legal ground
Notice of the Office of Qinhuangdao Municipal People's Government on printing and distributing the detailed rules for the implementation of the basic medical insurance for urban and rural residents in Qinhuangdao
Article 1 In order to further improve the basic medical security system for urban and rural residents in our city and safeguard the legitimate rights and interests of the participants in the basic medical insurance, according to the Social Insurance Law of People's Republic of China (PRC), the Regulations on the Supervision and Administration of the Use of Medical Security Funds, the Implementation Opinions of the People's Government of Hebei Province on Deepening the Reform of the Medical Security System (J.F.F. [2020] 13) and the Implementation Opinions of the Hebei Provincial Department of Finance on Implementing the National Medical Security Benefits List System of Hebei Provincial Medical Security Bureau.
The basic medical insurance for rural residents in Nijo Castle adheres to the principle of "fixed income and expenditure, balance of payments and slight surplus", and implements municipal overall planning, with unified fund collection and expenditure. Establish a basic medical insurance system for urban and rural residents with unified coverage, payment policy, treatment level, fund management, fixed-point management, payment management, handling services and information system.
Article 3 A basic medical security system covering the whole people and guaranteeing basic and fair enjoyment shall be established. The basic medical insurance system for urban and rural residents is applicable to the following objects within the administrative area of this Municipality: urban and rural residents who have not participated in the basic medical insurance for employees among the permanent residents of our city; Persons who live in our city and hold Hong Kong, Macao and Taiwan residents' passes to and from the Mainland and Hong Kong, Macao and Taiwan residents' residence permits; Persons living in our city with passports and foreigners' permanent residence permits; Pre-school children, primary and secondary school students (including vocational high schools, technical secondary schools and technical schools) who are not registered in our city and attend kindergartens in urban and rural areas all the year round and all kinds of full-time students in ordinary colleges and universities in our city (hereinafter referred to as college students).