Dalian employee medical insurance personal account transfer will adjust the counting method starting from this year

Starting from January 1, 2023, our city has officially launched the employee medical insurance outpatient financial security mechanism. Employees’ medical insurance enrollees will coordinate designated medical institutions in general outpatient clinics to collect drugs in the medical insurance catalog. , examination, treatment and other expenses can be reimbursed by the medical insurance coordinating fund according to policies, and the upper limit of reimbursement in a natural year is 10,000 yuan. The crediting method for medical insurance personal accounts will be adjusted in accordance with relevant national and provincial requirements. Employees on the job of the employer allocate 2% of their own insurance payment base to their personal accounts every month, and the employer's payment part is all included in the overall fund. The monthly quota of retirees’ medical insurance personal accounts is 80 yuan, which is the highest standard in the province.

After the reform, the level of outpatient medical reimbursement has been significantly improved. The change in personal account transfer standards is part of the economic reform of employee medical insurance outpatient services. The focus of the reform is to significantly increase the level of outpatient reimbursement for insured persons. After the reform, the reimbursement standards for outpatient medical expenses for employees are as follows: ■ The minimum payment standard is cumulative on an annual basis. The lower the level of the medical institution, the lower the minimum payment standard. Special third-level hospitals (including the First Affiliated Hospital of Dalian Medical University and the First Affiliated Hospital of Dalian Medical University) Second Hospital, Dalian Central Hospital, Zhongshan Hospital Affiliated to Dalian University), other third-level, second-level and first-level hospitals (community health service centers, health centers and other medical institutions that are not rated according to regulations shall follow the standards of first-level hospitals) The annual cumulative minimum payment standards for the employee medical insurance pooling fund are 1,000 yuan, 700 yuan, 500 yuan and 300 yuan respectively. ■ The payment ratio is determined by level. The lower the level of the medical institution, the higher the payment ratio. The reimbursement ratios for active personnel in third-level (including special third-level and other third-level), second-level and first-level hospitals are 50%, 60% and 70% respectively; the reimbursement ratio for retirees is 5 percentage points higher than that for active personnel. ■ Provide preferential policies for special diseases. The annual cumulative minimum reimbursement standard for specialized hospitals for infectious diseases and mental illnesses is 300 yuan, and the reimbursement rate for employees is 70% and 75% for retirees. ■ Encourage insured persons to sign contracts with family doctors. If insured persons sign up with family doctors in primary medical institutions to upgrade service packages, and receive treatment at contracted primary medical institutions, the payment ratio will be increased by 10 percentage points. ■ The annual basic medical insurance co-ordination fund payment limit is 10,000 yuan, which can protect the outpatient medical treatment and drug purchase of the vast majority of insured persons.

Minimum payment standards and reimbursement ratios for employee outpatient clinics’ overall reimbursement