Jiangxi Provincial People’s Government reports that Jiangxi has launched 20 measures to facilitate medical insurance and benefit the people. From next year, the reimbursement for outpatient service fo
Recently, Jiangxi Provincial Medical Security Bureau issued "Several Measures for Convenience and Benefits of Medical Security Departments in the Province" and launched 20 measures for convenience and benefits. It is mentioned that there is no waiting period for the treatment of the needy population, which can be "enjoyed immediately"; Outpatient chronic and special diseases are directly settled for medical treatment across provinces and different places; The masses can implement instant settlement by swiping their cards in designated village (community) clinics; Before the end of this year, the masses went to different places for medical treatment, and canceled the referral and other proof materials.
Cancel the capping line for reimbursement of serious illness insurance such as urban and rural subsistence allowances.
Ordinary residents participate in medical insurance for urban and rural residents by combining individual contributions with government subsidies, and can pay through various channels such as WeChat, tax App, banks and offline halls. The individual contributions of the poor population to participate in the medical insurance for urban and rural residents are partly funded by the government according to regulations. For the newly identified population in difficulty after the payment period of centralized medical insurance for urban and rural residents, they can be insured at any time and enjoy treatment at any time, without waiting period for treatment.
If the employee’s medical insurance insured person is interrupted for 3 months (inclusive) due to the transfer of medical insurance relationship, he can go through the formalities of medical insurance premium payment in the transferred medical insurance agency, and enjoy the waiting period without treatment after payment, and enjoy the treatment from the next day of payment. The treatment during the interruption period can be enjoyed retroactively according to regulations. Institutions and institutions that recruit, select and serve in different places can go through the transfer procedures of medical insurance before the establishment of personnel or the salary relationship, so as to ensure the seamless connection of the treatment of the employees.
We will fully implement the policy of coordinating outpatient services for urban and rural residents, and there is no deductible line for medical treatment in designated medical institutions at or below the first level, and the reimbursement rate will reach about 65%. Insured residents can implement instant settlement by swiping their cards in designated village (community) clinics. From January 1, 2023, the outpatient medical insurance for employees will be co-ordinated, and the proportion of reimbursement for medical treatment in designated medical institutions will be no less than 50%, so as to gradually realize the mutual assistance of individual medical insurance accounts for employees. The implementation of outpatient treatment of chronic and special diseases, drugs, diagnosis and treatment items and medical consumables that meet the needs of outpatient treatment of chronic and special diseases can be included in the scope of fund payment according to regulations.
Within the scope of the basic medical insurance policy for employees and urban and rural residents, the proportion of hospitalization expenses paid by the fund is stable at around 80% and 70% respectively. The deductible line of serious illness insurance for destitute dependents, orphans, urban and rural subsistence allowances and people returning to poverty will be reduced by half, accounting for 25% of the annual per capita disposable income of urban and rural residents, and the reimbursement ratio of serious illness insurance will be increased by 5 percentage points to 65%, and the top line will be cancelled.
The relief object is identified at any time, insured at any time, and enjoys treatment at any time. Before the end of 2022, the recipients who have standardized referral and sought medical treatment in the province will be given inclined assistance according to the application after being paid by the triple system of basic medical insurance, serious illness insurance and medical assistance, so as to effectively prevent poverty caused by returning to poverty due to illness.
Further simplify the handling links and evaluation procedures of designated medical insurance applications, shorten the waiting time of medical institutions, and the evaluation time shall not exceed 3 months from the date of accepting the application materials.
Realizing "Commitment System" for Self-service Filing for Medical Treatment in Different Places
Simplify the filing procedures for medical treatment in different places. On the basis of canceling the residence permit, the certificate of the neighborhood Committee of the resettlement place, the work certificate of the unit, the household registration book and other certificates for medical treatment in different places, the referral and emergency proof materials will be further cancelled before the end of 2022, and the "commitment system" self-service filing will be fully realized.
By the end of 2022, we will realize the cross-provincial direct settlement and full coverage of the treatment expenses for chronic and special diseases in five major outpatient clinics, including hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors, uremia dialysis and anti-rejection treatment after organ transplantation in 12 overall planning areas of the province.
Relax the selection scope of designated medical institutions for outpatient chronic and special diseases. According to the actual situation, the medical insurance department in the overall planning area can allow the insured persons with chronic and special diseases in outpatient clinics to choose two or more designated medical institutions as designated hospitals for chronic and special diseases in outpatient clinics before October 1, 2022.
For the insured persons with chronic diseases who really need it, after being evaluated by doctors in designated medical institutions, the prescription dosage will be relaxed to 12 weeks, and the medical insurance fund will be settled according to regulations.
The medical insurance handling service hall provides delayed service on weekends.
For drugs and medical consumables purchased with centralized quantity, the medical insurance fund shall be directly settled with pharmaceutical enterprises, so as to speed up the withdrawal of funds from enterprises and reduce the transaction costs of enterprises.
Revise the list of public service items and service guide of the platform, standardize the online processing process, and realize the "all-process network operation" and "one-network operation" of the whole process business such as new product hanging, information change and distribution relationship confirmation of pharmaceutical enterprises.
Optimize the service process of medical insurance management. Improve the standardization level of medical insurance handling services. In accordance with the principles of "reducing materials, processes and time limits" and "minimum necessity", the List of Administrative Services for Medical Insurance in Jiangxi Province was revised to further optimize the service process, simplify the application materials and shorten the processing time limit.
The service halls of medical insurance agencies at all levels provide delayed services at noon on weekdays, weekends and legal holidays, smooth the channels of appointment services, and provide 365-day "non-closing" medical insurance window handling services.
Promote the "online office" of high-frequency medical insurance services. Through the online service hall of Jiangxi Medical Insurance, the "Jiangxi Smart Medical Insurance" App, and the "Ganfutong" medical insurance zone, the high-frequency service items in the medical insurance field, such as enrollment registration, enrollment information change, basic medical insurance relationship transfer and connection, and personal account details inquiry, have been realized, and the scope of "inter-provincial communication" and "intra-provincial communication" has been continuously expanded.
Promote the use of the whole process of medical insurance electronic certificate in designated medical institutions
Accelerate the construction of the five-level medical security management service system at the provincial, city, county (district), township (street) and village (community). By the end of 2022, the medical security service items such as urban and rural residents’ insurance registration and medical treatment in different places will be included in the service scope of grassroots government service outlets, so that the insured can "do it nearby, do it once and do it quickly".
For the medical expenses that are not directly settled by the insured, the medical insurance department in the overall planning area shall relax the reporting time limit for manual (sporadic) reimbursement of medical expenses according to the actual situation, and shall not refuse to accept the sporadic reimbursement application of the insured people on the grounds of exceeding the reporting time limit.
The conditions for employees to enjoy maternity medical expenses and maternity allowance shall be implemented in accordance with the Notice of the General Office of the People’s Government of Jiangxi Province on Printing and Distributing the Implementation Measures for the Merger of Maternity Insurance and Basic Medical Insurance for Employees (No.94 [2019] of Gan Fu Ting Zi), and other existing additional conditions shall be cancelled before October 1, 2022. The conditions for urban and rural residents to enjoy reimbursement of maternity medical expenses are consistent with basic medical insurance.
Realize the multi-scenario application of medical insurance in electronic certificate, public service inquiry, personal insurance information inquiry and so on, and promote the whole process of medical insurance services such as registration, medical treatment, payment, and drug collection in designated medical institutions, so that the insured personnel can have one yard in hand and have no worries about medical insurance.
Carry out activities such as "leaders receiving visits to Japan", "hospital reception day" and "enterprise reception day" to interpret the medical insurance policy and respond to the concerns of the masses.