In recent years, by strengthening fund supervision, consolidating the foundation of payment, expanding coverage, combining maternity insurance with basic medical insurance, and eliminating empty accounts, the medical insurance fund in our city has achieved the goal of "breaking even and having a slight balance" since 2020. In order to enable the broad masses of the people to fully enjoy the fruits of the reform and development of medical insurance, the Chifeng Municipal People's Government deliberated and passed the 18 executive meeting, and the Chifeng Municipal Medical Security Bureau issued the Opinions on Adjusting the Relevant Policies of Medical Insurance in our City on 2021215 (Chibaofa [20265438]). On the basis of increasing the reimbursement ratio of chronic diseases in-patients and outpatients of secondary and tertiary medical institutions for urban and rural residents according to hospitalization management, the policy of deducting the reimbursement ratio of irresponsible accidental injuries 10% was abolished, and the out-of-pocket ratio of Class B drugs for all insured persons was reduced 10% in July 2026, which provided insured persons with higher reimbursement ratio, wider coverage and stronger sense of acquisition.

This policy adjustment covers urban and rural residents' medical insurance and employees' medical insurance, benefiting 4 million insured people in the city. Focus is adjusted to:

I. Adjustment of medical insurance policies for urban and rural residents. Mainly in three aspects: increase the maximum payment limit of basic medical insurance, increase the proportion of reimbursement in each paragraph, and cancel the maximum payment limit of serious illness medical insurance.

(1): The threshold of first-,second-and third-level designated medical institutions remains unchanged, and the maximum payment limit of basic medical insurance is adjusted from 6.5438+0.2 million yuan within the policy scope to 6.5438+0.2 million yuan actually paid. For a simple example, in the third-level designated medical institutions in Chifeng City, the original policy can reimburse up to 75,000 yuan per year, and from 2022 onwards, the maximum reimbursement can be 1.2 million per year.

(2): The proportion of payment in each paragraph of the second-and third-level designated medical institutions increased by 3 percentage points. Based on the preferential policy of 202 1, the reimbursement rate within the policy scope in early 2022 is about 8 percentage points higher than that in early 20021.

(3): Cancel the original maximum payment limit of 250,000 yuan for serious illness insurance, without setting a capping line, and the minimum payment standard and reimbursement ratio remain unchanged. (Whether to raise the original limit)

Second, employee medical insurance The current employee medical insurance policy system consisting of "basic medical insurance, social medical assistance insurance and serious illness medical insurance" has been adjusted to a new employee medical insurance policy system consisting of "basic medical insurance and large medical expenses subsidies". It is mainly manifested in three aspects: increasing the maximum payment limit of basic medical insurance, increasing the proportion of reimbursement in each paragraph, and implementing large medical expenses subsidies.

(1): The minimum payment standard of first-,second-and third-level designated medical institutions remains unchanged, and the maximum payment limit of basic medical insurance is adjusted from 350,000 yuan within the policy scope to 350,000 yuan actually paid. For example, the third-level designated medical institutions in Chifeng City, the original policy can be reimbursed up to 306,000 per year; From 2022, the annual reimbursement can reach up to 350,000.

(2) Increase the proportion of reimbursement by installments for basic medical insurance, increase the proportion of medical expenses below 6,543.8+0.5 million yuan by 5 percentage points, and increase the proportion of medical expenses above 6,543.8+0.5 million yuan by 2 percentage points.

(3): The deductible line of the large medical expenses subsidy for employees is 1 1,000 yuan, and the medical expenses above 1 1,000 yuan within the scope of the individual cumulative burden policy are paid at 90%, and there is no capping line.

In 2022, the centralized payment period of basic medical insurance for urban and rural residents will end on 65438+February 3 1 day, reminding the majority of urban and rural residents to pay for insurance as soon as possible, so as not to affect their enjoyment of medical insurance benefits next year; Flexible employees can choose to participate in the basic medical insurance for employees or the basic medical insurance for urban and rural residents.

The medical security department of Chifeng City will deeply practice the development concept of "life first, health first and people-oriented", constantly improve the multi-level medical security system covering the whole people, coordinating urban and rural areas, being fair and unified, ensuring moderate coverage, participating in insurance according to law and being sustainable, improve the financing mechanism of medical insurance, optimize the proportion of reimbursement by stages, and take "medical insurance benefits more people, works in Dont Ask For Help, and insured people run fewer errands" as the working goal, and continue to crack down on fraudulent insurance.