Beijing personal medical insurance accounts will be used in a targeted manner from September, and there will be no capping line for employee outpatient benefits from next year.
On August 19, the reporter learned from the Beijing Municipal Medical Insurance Bureau that starting from September, personal medical insurance accounts will be used for targeted use, and they will no longer be available for immediate use. Funds in personal accounts before September 1 can still be freely withdrawn in the future. In 2022, the threshold for serious illness of employees will be reduced to 30,404 yuan. From next year, there will be no cap line for outpatient treatment of employees in Beijing, and 60% will be paid for outpatient (emergency) clinics above 20,000 yuan.
Outpatient (emergency) diagnosis more than 20,000 yuan will be paid at 60%
Recently, 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 Relevant Policies of Beijing Urban Employee Basic Medical Insurance” to further improve the employee medical insurance system and increase personal accounts. Efficient use of funds, reducing the burden of medical expenses for employees.
At present, the maximum payment limit for outpatient (emergency) medical expenses incurred by the insured persons of Beijing Employee Medical Insurance within one year in line with the payment regulations of Beijing Basic Medical Insurance is 20,000 yuan, and the excess of 20,000 yuan is 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 employees over 20,000 yuan, and 80% for retirees (including retirees’ unified supplementary medical care) 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.
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 RMB 50,000 (ie, RMB 30,404 to RMB 80,404), and 70% for the portion above RMB 50,000 (ie, RMB 80,404), with no ceiling. It is expected to benefit 35,000 insured persons every year and reduce the burden of insured persons by 120 million yuan.
Targeted use of personal accounts from September 1
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. Under the age of 70 (excluding), it is credited at 100 yuan/month, and over 70 years old is credited at 110 yuan/month.
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 the insured at any time in the future.
From December 1, 2022, spouses, parents and children who participate in the basic medical insurance of Beijing 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 Beijing, and purchase supplementary medical insurance in Beijing (specifically, Beijing Inclusive Health Insurance at this stage).
Beijing News reporter Ma Jinqian
Edited by Bai Shuang, proofreaded by Chen Diyan
