Payment standards, off-site reimbursement... Hunan Provincial Medical Insurance Bureau’s interpretation is here

Recently, the Hunan Provincial Medical Security Bureau, the State Administration of Taxation, the Hunan Provincial Taxation Bureau, the Hunan Provincial Department of Education, the Hunan Provincial Department of Civil Affairs, the Hunan Provincial Department of Finance, the Hunan Provincial Rural Revitalization Bureau, and the Hunan Provincial Disabled Persons Federation For the specific content of the "Notice on Carrying out the Participation and Payment of Basic Medical Insurance for Urban and Rural Residents in 2023", click "350 yuan/person! Hunan's 2023 individual payment standards for resident medical insurance are clear". Recently, in response to the hot issues that everyone is concerned about, the Provincial Medical Security Bureau has made an interpretation. Come and take a look ↓↓↓ Regarding the financing and payment standards, residents’ medical insurance fees for the following year are collected from September to December every year. The financing and payment standards are the same in the province. Unify and implement national minimum standards. According to the notification requirements of the National Medical Insurance Administration, the Ministry of Finance, and the State Administration of Taxation, the financing standard for resident medical insurance in 2022 is 930 yuan, including a financial subsidy of 610 yuan per person and an individual payment of 320 yuan; the per capita financial subsidy standard for resident medical insurance in 2023 will be announced nationwide in 2023. It can only be determined after approval by the National People's Congress meeting, and the individual payment standard is 350 yuan. Therefore, in 2023, the financing standard for Hunan’s resident medical insurance will be no less than 960 yuan per person, of which the financial subsidy will be no less than 610 yuan (the specific standards are implemented in accordance with national regulations), and individuals only need to pay 350 yuan. Against the background of rapid advancement in medical technology, continued growth in medical expenses, gradual release of residents’ medical needs, and steady improvement in treatment levels, financing standards need to be reasonably increased to support the insured’s medical insurance treatment expenditures and the long-term stable performance of system functions. Regarding the insurance subsidy policy for the needy people, the individual contributions of the extremely poor people participating in the resident medical insurance will be fully subsidized (severely disabled people, orphans, and de facto unsupported children will be implemented as a reference), and subsistence allowance targets, monitoring targets, and families on the margins of the minimum living security will be fully subsidized. Members provide half funding. Each city or state may, based on actual conditions, provide appropriate subsidies for the individual contributions of other needy groups participating in resident medical insurance. The specific standards shall be determined by the local people's government. Encourage qualified towns, streets, collectives, units or other social and economic organizations to provide support or subsidies for urban and rural residents to participate in insurance premiums. Regarding benefits and benefits: The benefits benefits period is from January 1, 2023 to December 31, 2023. Insured persons can enjoy the following medical insurance benefits: Outpatient coordination: Insured residents receive outpatient services for general outpatient services and 43 chronic diseases and special disease outpatient clinics at primary medical and health institutions. There is no deductible for medical expenses within the scope of the policy, and the reimbursement rate is 70% within the limit, and the annual reimbursement rate is 70%. The limits are set by each city and state based on actual conditions. "Two diseases" drug protection: When insured residents with hypertension and diabetes seek medical treatment at primary medical and health institutions, there is no deductible for the expenses within the scope of the "two diseases" drug policy. The reimbursement rate within the limit is 70%, and the annual maximum reimbursement for hypertension is 360 yuan for patients with diabetes, 600 yuan for diabetes, and the maximum reimbursement that meets the access standards for chronic and special disease outpatient protection is 1,800 yuan. Hospitalization coverage: Insured residents’ hospitalization medical expenses incurred in designated medical institutions within the scope of the policy, the minimum payment line is not less than 200 yuan for township health centers, not less than 500 yuan for county-level hospitals, not less than 1,000 yuan for municipal-level hospitals, and provincial The hospital level is determined based on about 10% of the average hospitalization cost in the previous year (1,500 yuan to 2,300 yuan). The reimbursement ratio is no less than 80% for township hospitals, no less than 70% for county-level hospitals, no less than 60% for municipal hospitals, and no less than 50% for provincial hospitals (divided into three levels: 50%, 55%, and 60%). . The annual maximum limit for hospitalization reimbursement is 150,000 yuan. Critical illness insurance: The accumulated out-of-pocket hospitalization expenses within the policy scope of insured residents exceeding the threshold of critical illness insurance will be compensated in stages. The threshold is determined based on about 50% of the per capita disposable income of residents in the previous year; after deducting the threshold of critical illness insurance , 60% is reimbursed for the portion ranging from 0 to 30,000 yuan (inclusive), 65% is reimbursed for the portion exceeding 30,000 yuan to 80,000 yuan (inclusive), 75% is reimbursed for the portion exceeding 80,000 yuan to 150,000 yuan (inclusive), and 75% is reimbursed for the portion exceeding 150,000 yuan. Partial reimbursement is 85%; annual limit is 400,000 yuan. The minimum payment line for people in need will be reduced by 50%, the reimbursement rate will be increased by 5%, and there will be no cap. Medical assistance: According to the "Hunan Provincial Medical Assistance Measures", medical assistance objects are divided into three categories, and they enjoy insurance subsidies, outpatient assistance, and hospitalization assistance according to category. The annual limit for outpatient medical assistance does not exceed 8,000 yuan. There is no deductible for first-class assistance, and the assistance ratio is 90%. The deductible for second-class assistance is 1,000 yuan, and the assistance ratio is 50%. Outpatient assistance for major and serious diseases is based on hospitalization standards. Annual limits and hospitalization assistance*** expenses.

The annual limit for hospitalization medical assistance shall not exceed 100,000 yuan. There is no deductible for first-category assistance, and the assistance ratio is 90%. The deductibles for second- and third-category assistance are respectively 5% and 25% of the per capita disposable income of residents in the previous year. , the rescue ratios are 70% and 50% respectively. Assistance recipients who are still at risk of returning to poverty after receiving medical assistance subsidies can apply for re-assistance. The specific assistance standards are reasonably determined by each city and state based on the medical assistance funds and financial support capabilities of the region. Regarding the scope of medical insurance reimbursement, drugs: The varieties of the national medical insurance drug catalog continue to increase every year, and the coverage continues to expand. The 2021 version of the drug catalog contains 2,860 drugs, 151 more than in 2019. Most of the added varieties are negotiated drugs within the national agreement period, and drug prices have been significantly reduced. On the basis of the national drug catalog, 716 preparations produced by medical institutions in the province have been included in the medical insurance reimbursement; 551 kinds of traditional Chinese medicine pieces have been included in the medical insurance reimbursement, further expanding the scope of drug protection for insured persons. Consumables: 40,600 types of medical consumables (corresponding to 20-digit national medical insurance codes) are included in the scope of medical insurance reimbursement, which can meet the basic medical needs of patients in various clinical departments. Medical service items: Based on the principles of clinical necessity, safety, effectiveness, and appropriate price, 3,225 medical service price items are included in medical insurance reimbursement, including 2,630 items in Category A (accounting for 81.5%) and 595 items in Category B (accounting for 18.5%). Regarding reimbursement for medical treatment in different places within the province and across provinces, the reimbursement process for medical treatment in different places within the province and across provinces is roughly the same. They all need to follow the steps of "first filing, selecting a point, and holding a code/card for medical treatment". Registration and selection of points can be completed through various channels such as online (National Medical Insurance Service Platform APP, Hunan Medical Insurance Official Account, Mini Program, APP), handling window, telephone, etc. If direct settlement cannot be made for some reason, you can also return to the insured place for manual reimbursement according to the regulations of the insured place with the original invoice, original expense list, copy of your bank account, insured person's ID card or social security card. Regarding medical insurance identity verification: After enrolling in the insurance, residents can verify their insurance identity through their ID card, social security card, and electronic medical insurance voucher. Among the three identity media, the electronic medical insurance voucher is the most convenient. After the resident medical insurance participants activate it through the national medical insurance service platform APP or Hunan Medical Insurance official account, mini program, APP, etc., they can meet the relevant medical insurance business needs by displaying the code on their mobile phones. Since Resident Medical Insurance does not have a personal account, Resident Medical Insurance does not issue physical medical insurance cards. The physical medical insurance card of the employee medical insurance participant is actually a personal account bank card. Regarding the insurance payment time, the centralized insurance payment period for residents’ medical insurance in 2023 is in principle from September 1 to December 31, 2022. In co-ordination areas that fail to reach the required insurance participation rate as scheduled, the centralized insurance payment period can be appropriately extended to February 28, 2023. Regarding the insurance participation method, in order to ensure that basic medical insurance is fair and universally beneficial, and to curb speculation and selective participation in insurance, according to the "Basic Medical Treatment and Health Promotion Law of the People's Republic of China" on "Citizens have the right to participate in basic medical insurance in accordance with the law" "Rights and Obligations" and the national universal insurance requirements. The payment method is in accordance with the principle of territorial management. Urban and rural residents (including primary and secondary school students and preschool children) participate in the insurance in the family unit at the place of household registration or permanent residence. College and technical secondary school students (including freshmen) are insured as a whole on a school basis at the school location. The school collects and pays resident medical insurance premiums on its behalf, and handles insurance registration procedures in a unified manner. Regarding payment channels, according to the unified deployment across the country, the taxation department is responsible for collecting medical premiums. Advocate "contactless" payment methods such as Hunan Taxation Social Security APP, WeChat applet, and mobile banking; at the same time, we also fully consider the needs of the masses and retain methods such as manual counters and village (community) staff for collection and payment.