The “Homepage Highlights” column opened by Junction News recommends the most timely news and information, the most important hot events, and the most memorable people and events through keywords every day. Today, we recommend the keyword-medical insurance.
Meeting point news across the province’s cross-coordinated areas of mutual recognition of medical insurance payment years for mobile employment, all designated pharmacies in districts and cities can directly swipe the medical insurance card for settlement of drugs purchased from other places, flexible employees can participate in employee medical insurance, and 32 “15-minute medical insurance service circles” have been built. , To achieve medical insurance “no small things out of town, the masses’zero errands'”…
The Jiangsu Provincial Medical Insurance Bureau held a press conference on October 20 to inform the bureau that in the practice of “I do practical things for the masses”, it has launched a series of problems in the medical security field that the people have reported. Measures to facilitate, benefit and benefit the people.
Mutual recognition of medical insurance payment periods for mobile employment in cross-coordination areas in the province
It is understood that the medical insurance for employees across the country is currently under localized management. Unlike pension insurance, which has achieved provincial-level overall planning, most of the overall medical insurance level still stays at the level of districts and cities, and the medical insurance payment standards and treatment standards in each region are all different. different. All localities have a minimum payment period requirement for insured persons to enjoy medical insurance benefits when they retire. For example, some districts and cities stipulate that migrant workers in cross-regions must pay locally for 10 consecutive years before they can enjoy medical insurance retirement benefits. For those who switch jobs between cities, if the payment period fails to reach the minimum payment period set by the local government, they will not be able to enjoy the due medical insurance benefits after retirement.
To this end, the Provincial Medical Insurance Bureau issued a special notice to clarify that insured persons who have not reached the statutory retirement age and transferred employee medical insurance relationships across the province due to floating employment, such as transfer from Nanjing to Suzhou, the Suzhou medical insurance department will The payment period (including the deemed payment period and the actual payment period) for insurance personnel participating in the basic medical insurance for employees in Nanjing shall be mutually recognized and calculated cumulatively.
Regulate the medical insurance relationship of employees in the province to enjoy the connection of benefits when transferring across the coordinated area, and it is clear that if there is no interruption of payment, the medical expenses incurred in the month of payment in the new place of employment will be reimbursed by the medical insurance agency in the new place of employment as required to prevent new employment Because of the “insurance in the current month, enjoy the treatment next month” regulations, there is a gap in treatment. In case of interruption, if the interruption time does not exceed 3 months, after the interruption period medical insurance premiums are made up, it will be regarded as continuous participation; if the medical insurance premiums are not supplemented as required or the interruption time exceeds 3 months, the interruption period is in principle The medical expenses of the company will no longer be reimbursed.
The “Notice” also clarified the principle of determining the place where migrant workers in the province can enjoy medical insurance benefits when they reach the retirement age. In the case of separation of the place of receiving basic endowment insurance benefits of enterprise employees and the place of employee medical insurance, the medical insurance relationship of migrant workers is clarified to prevent the separation of the place of receiving basic pension insurance benefits of enterprise employees from the place of employee medical insurance. Unreliable phenomenon.
“15-minute medical insurance service circle” begins to take shape
In order to facilitate the masses to handle medical insurance business, the provincial medical insurance department will create a “15-minute medical insurance service circle” with high standards this year. Up to now, 32 grassroots “15-minute medical insurance service circle” demonstration sites have been fully completed and put into use, serving 66,900 people insured at the grassroots level, basically realizing the medical insurance “no small things out of town, no errands for the masses”. .
It is understood that the service area of each demonstration site is not less than 150 square meters, with 7 types of functional areas including guidance and consultation area, self-service area, call waiting area, counter acceptance service area, maternal and child room, various office supplies, Convenience service facilities are all available, and guide signs such as zone guide signs and plane distribution maps are unified, standardized, and clear.
In accordance with the province’s unified business process specifications, Jiangsu will include all high-frequency service matters closely related to the insured people at the grassroots level into the demonstration sites for processing. The average processing time for “immediate” medical insurance matters will not exceed 10 minutes, and attention will be paid to online and offline channels. The integration, the same quality and the same standard are applied to realize the non-stop and non-closing medical insurance services. For the elderly and other special groups of people, diversified green services such as assistance agency, acceptance of vacancies, appointment processing, delayed services, on-site services, etc. have been opened.
Image source: Visual China
Each demonstration site is also equipped with 3-5 medical insurance public service personnel, who are recruited in a unified manner by the districts and cities, and on-the-job training is carried out on a regular basis. Strictly implement the first-inquiry responsibility system, one-time notification, time-limited settlement, commitment system, comprehensive teller system, information disclosure, and other systems and regulations, open complaints and reports, and actively accept public supervision.
All designated pharmacies in districts and cities can purchase medicines directly from the medical insurance card
When insured persons seek medical treatment in different places in the province, the most troublesome thing is that they cannot purchase medicines by swiping their medical insurance cards at retail pharmacies in other places. In the practice activity of “I do practical things for the masses” of party history learning and education, Jiangsu insisted on the linkage of provinces and cities, unified standardization, and joint efforts to tackle tough problems, and did a good job in the evaluation and selection of designated pharmacies, platform transformation and docking, and system joint debugging and testing. As of October 18, all districts and cities in the province have achieved direct settlement of drug purchases in designated retail pharmacies for medical treatment in different places in the province. A total of 1,599 designated retail pharmacies for direct settlement of drug purchases in different places in the province have been opened, and direct settlement of drug purchases in different places has been 4148 person-times. The settlement amount is 680,300 yuan.
Image source: Visual China
According to reports, the purchase of drugs in remote networked pharmacies implements the province’s unified medical insurance catalog, and the reimbursement and settlement benefits are consistent with the policy of the insured area; in order to simplify and standardize the settlement process, Jiangsu has included the direct settlement costs of drug purchases in remote networked pharmacies into the scope of settlement of outpatient expenses for medical treatment in remote locations. , The medical insurance agency in the place of medical treatment directly settles with the designated retail pharmacy, and the provincial medical insurance agency conducts unified settlement, which shortens the settlement cycle and increases the enthusiasm of the designated retail pharmacy to provide services for purchasing medicines in different places.
At the same time, Jiangsu has also realized the seamless connection between the “no-meet” filing of medical treatment in different places and the direct settlement of medicine purchases in different places through various channels such as Jiangsu Medical Insurance Cloud, WeChat official account, and mobile APP. You can simultaneously open a pharmacy for direct settlement of purchases of medicines in different places. At the same time, the online query function is optimized, and the list of designated retail pharmacies that have opened direct settlement for drug purchases in different places is dynamically updated in real time. Participants can log in to the portal website of the Jiangsu Provincial Medical Security Bureau to query at any time.
Xinhua Daily · Meeting Point reporter Huang Hongfang