Recently, Zhangzhou City The Medical Security Bureau, together with Zhangzhou Health Commission and Zhangzhou Finance Bureau, issued the Notice on Issues Related to Improving the Treatment of Basic Medical Insurance Policies in Zhangzhou (hereinafter referred to as the "Notice"), making appropriate adjustments to the medical insurance for employees and medical insurance for urban and rural residents in Zhangzhou from six aspects. The policy will be implemented from January 1, 2024, of which the medical insurance benefit policy for employees will be valid until December 31, 2026, and the medical insurance benefit policy for urban and rural residents will be valid until December 31, 2027.
Reduce the deductible standard for hospitalization outside the city
The maximum reduction is 950 yuan
The Notice points out that this policy adjustment will reduce the off city hospitalization minimum payment standard for urban and rural residents. After the adjustment, hospitalization outside Zhangzhou has been adjusted from the original 1300 yuan regardless of hospital level to 1100 yuan for tertiary hospitals, 700 yuan for secondary hospitals, and 350 yuan for primary hospitals. Those who have been hospitalized in secondary hospitals or above for many times in a year will decrease by 200 yuan to 0 yuan in turn. Before the adjustment, the deductible standard for out of city hospitalization of resident insured persons was 1300 yuan regardless of grade.
This policy adjusted the off payment standard for medical treatment outside the city according to the level, reducing the maximum by 950 yuan, further reducing the burden of insured people on medical treatment outside the city.
Increase the proportion of large amount medical subsidy reimbursement for employees
We will improve the protection of serious illness insurance benefits for urban and rural residents. The Notice clearly requires that the large amount of medical subsidies for employees and serious illness insurance benefits for urban and rural residents should be further improved by increasing the proportion of reimbursement and optimizing the segmentation model. Among them, in terms of medical insurance for employees: medical expenses within the scope of medical insurance policies that meet the standard of large amount medical subsidies for employees, the original reimbursement ratio is 90% for diseases, and further improve the treatment guarantee, and implement the reimbursement ratio of 95%; In terms of medical insurance for urban and rural residents: optimize the progressive reimbursement standard of serious illness insurance for urban and rural residents. For the range of serious illness insurance from the minimum payment standard to 70000 yuan (excluding 70000 yuan), the expenses within the policy range are divided into three different reimbursement ratios (60% for those below 30000 yuan, 70% for those between 30000 yuan and 50000 yuan, and 80% for those between 50000 yuan and 70000 yuan), The unified adjustment is to pay 80%, and pay 90% for 70000 yuan and above.
Adjust the proportion of Class B self payment of medical service projects in Zhangzhou
The Notice clearly mentioned that the provision of "the proportion of Class B self payment of medical service items (medical consumables) above 10% (excluding 10%) will be increased by 5 percentage points" in the implementation measures of basic medical insurance in Zhangzhou City will be canceled, and the medical service items and the proportion of Class B self payment of medical consumables in Zhangzhou City will be implemented according to the current provincial standards to further improve the quality of Zhangzhou residents The proportion of hospitalization reimbursement within the scope of employee medical insurance policy.
Ensure that the reimbursement ratio of referral benefits increases by 10%
In order to encourage people to see a doctor in a medical institution below Grade III A, if it is true that a lower level medical institution does not have the conditions to carry out diagnosis and treatment, it shall be transferred to a higher level hospital for medical treatment according to regulations, and enjoy the treatment guarantee of transfer. The Notice clearly stated that if urban and rural residents insured go to Zhangzhou Third Class A Hospital (Zhangzhou Hospital, Zhangzhou Hospital of Traditional Chinese Medicine, and 909 Hospital of Joint Service Support Force) for medical treatment through the grassroots referral procedure required by the health department, the medical insurance reimbursement ratio will increase from 55% to 65% after completing registration at the medical insurance agency window with relevant referral materials.
Expand the scope of implementation outside the city of general outpatient service planning of employee medical insurance
In order to further liberalize the implementation scope of the general outpatient service plan for employees outside the city, and facilitate the one-stop card payment for insured employees in Zhangzhou when they seek medical treatment in the general outpatient service outside the province, the Notice clearly states that the implementation scope of the general outpatient service plan for employees' medical insurance outside the city is based on the original public medical institutions, and further expands its coverage to private medical institutions at level II and above.
The reimbursement standard for hospitalization in compact county medical community is given preference
In addition, in order to keep patients at the county level, achieve the goal of "serious diseases do not leave the province, common diseases are in the cities and counties, and daily diseases are at the grass-roots level", promote the implementation of the construction of close medical community at the county level in Zhangzhou City, and give full play to the role of hierarchical diagnosis and treatment, the Notice also clearly requires that the close medical community at the county level that has implemented the unified medical insurance financial account and implemented package payment, The minimum payment standard for hospitalization was inclined. The basic medical insurance participants in Zhangzhou City seek medical treatment in the medical community, and the deductible standard for hospitalization in hospitals of Class II and above is reduced by 200 yuan, which is implemented as 600 yuan for hospitals of Class III and 200 yuan for hospitals of Class II. If there are multiple hospitalizations in the medical community in the year, the deductible standard is reduced by 200 yuan to 0 yuan (including hospitals of Class I). (Strait Leader reporter Lai Yahong ）
Original title: Zhangzhou lowers the off payment standard for hospitalization outside the city
Editor in charge: Li Xiaoling
