What is the reimbursement policy and the new reimbursement policy?

Legal analysis: New policy of medical insurance in 2022: basic medical insurance includes basic medical insurance for employees and medical insurance for urban residents, and the cost of medical insurance for urban residents is: one year is yuan. The basic medical insurance for employees shall be paid jointly by the employer and the individual.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by the risk of disease. Through the employer and individual payment, the establishment of medical insurance**, after the insured person is sick and incurs medical expenses, the medical insurance institution will give him a certain amount of economic compensation.

The establishment and implementation of the basic medical insurance system gathers the economic strength of the unit and the members of the society, coupled with the first funding, which can enable the sick members of the society to obtain the necessary material help from the society, reduce the burden of medical expenses, and prevent the sick members of the society from "becoming poor due to illness".

Medical insurance has the basic characteristics of social insurance, such as compulsory, mutual aid and sociality. The medical insurance system is usually enforced by national legislation, and the first system is established, the cost is jointly paid by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risk caused by the illness or injury of the worker.

Medical insurance, like other types of insurance, is a contract to collect medical insurance premiums in advance from people who are threatened by disease, and establish medical insurance**; When the insured falls ill and goes to a medical institution for medical treatment and incurs medical expenses, the medical insurance institution will give certain financial compensation. Therefore, medical insurance also has two major functions of insurance: risk transfer and compensation transfer.

That is, the economic loss caused by the risk of disease in the individual is apportioned to all members who are threatened by the same risk, and the economic loss caused by the disease is compensated by the centralized medical insurance**.

Commercial medical insurance can be divided into reimbursement medical insurance and compensation medical insurance.

Reimbursement-based medical insurance means that the medical expenses incurred by patients in the hospital are reimbursed by the insurance company, which is generally divided into outpatient medical insurance and inpatient medical insurance.

Indemnity medical insurance means that the patient is clearly diagnosed by the hospital with a certain disease listed in the contract, and the insurance company pays the patient** and care according to the amount agreed in the contract. Generally, there are two types of insurance: single illness insurance and critical illness insurance.

Legal basis: Article 23 of the Social Insurance Law of the People's Republic of China Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

2021 New Regulations on Non-local Medical Insurance Reimbursement: Cancel the filing materials, making it easier to seek medical treatment in other places.

The new policy will be:Two categories of personnelBringing benefits:The first is "long-term residents in other places"., including retirees, permanent staff, long-term residents in other places, migrant farmers, migrant workers and entrepreneurs, and other people who have lived in other places for more than 6 months; The second is "temporary out-of-office medical personnel"., including those who are referred to hospitals, those who go out for medical treatment on their own, and those who are temporarily seeking medical treatment abroad for business trips, family visits, tourism, etc.

In terms of remote medical treatment policyFirst, the online filing procedures for medical treatment in the province have been cancelledFor "temporary out-of-patient medical personnel" hospitalization, general outpatient clinics, and outpatient chronic diseases, individuals can directly go to hospitals in other places in the province with full ID cards and medical insurance cards for hospitalization**, and medical expenses are directly settled online; Second, the filing of cross-provincial and non-local medical treatment has cancelled the certification materials"Temporary out-of-town medical personnel" no longer need to provide referral applications, personal commitment letters and other supporting materials, "long-term residents in other places" no longer need to provide household registration certificates, residence permits and other supporting materials for the record, and insured persons can go to the window of the medical insurance government service hall and the grassroots medical insurance workstation for the record; It can also be handled through the national medical insurance service platform, and can be filed for medical treatment in other places through various channels such as the services announced by the medical insurance department.

What's even more heartwarming is that "long-term residents in other places" seek medical treatment in their long-term residence after filing for the recordA one-time filing is valid for a long time, and you can enjoy the same proportion of medical insurance reimbursement as that of medical treatment in the insured place.

Increase the reimbursement ratio and make medical treatment more affordable:After the introduction of the new policy, not only the process of handling medical treatment in other places is more convenient, but also the proportion of self-payment of cross-city and cross-provincial inpatient medical expenses in the province for "temporary medical personnel" has been reduced from no more than 40% to the original one；For general outpatient clinics and outpatient chronic diseases, there is no longer a first-to-pay ratio for cross-city and cross-provincial medical treatment within the province.

Outpatient reimbursement (including general outpatient and outpatient chronic diseases) is no longer limited by the level of medical institutions and the number of families. Insured persons who seek medical treatment in different cities and provinces within the province are not limited by the scope and level of contracted primary medical institutions and the number of homes, and can enjoy outpatient co-ordination treatment and realize online settlement, and the reimbursement amount in different places and the local reimbursement amount are calculated together, and do not exceed the outpatient co-ordination reimbursement amount of the current year.

Reimbursement regulations, 1. First of all, when the insured goes to see a doctor, the social security person will prescribe a prescription to pay after seeing the doctor. 2. The insured person takes the ** slip to the department to see a doctor, and the doctor goes to the ** place ** for the insurance card. 3. After the insured takes the prescription to the hospital settlement window for pricing, he can directly swipe the social security card to pay the medical expenses that are within the scope of medical insurance**.

4. If some of the drugs in the prescription are not covered by medical insurance, the insured is required to pay cash.

Legal basis] Article 8 of the Detailed Rules for the Implementation of the Social Insurance Law of the People's Republic of China in the medical institutions of the agreement of the insured persons, in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, in accordance with the provisions of the state from the basic medical insurance **. If the insured person really needs emergency treatment or rescue, he or she can seek medical treatment in a non-agreed medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific management measures for the medical services of emergency and rescue of the insured shall be formulated by the overall planning area according to the actual local situation.

If you still have questions about this issue, it is recommended that you organize the relevant information and communicate with a professional in detail.