The self payment standard for outpatient and emergency departments of in-service employees in Shanghai has been reduced from 1500 yuan to 500 yuan. Starting from July, the personal account | employee | standard
The reporter learned from the Municipal Medical Insurance Bureau that starting from 00:00 on July 1, 2023, the employee medical insurance in this city will enter the 2023 medical insurance year. According to the requirements of relevant documents, this city will implement multiple medical insurance policies to benefit the people, facilitate medical treatment and medication purchases, and reduce the burden of outpatient medical expenses.
One is to lower the threshold for reimbursement of outpatient and emergency expenses for employees of all age groups under medical insurance, and increase the proportion of outpatient and emergency expenses reimbursement. Among them, the self payment standard for outpatient and emergency departments of in-service employees has been reduced from 1500 yuan to 500 yuan; The proportion of outpatient and emergency medical reimbursement in primary, secondary, and tertiary hospitals has been increased to 80%, 75%, and 70%, respectively. The outpatient reimbursement threshold for retirees has also been reduced by varying degrees from 100 to 400 yuan, and the reimbursement ratio for some retirees has also been increased.
The second is to increase the maximum payment limit of the employee medical insurance pooling fund from 590000 yuan to 610000 yuan. The portion above the maximum payment limit can still be reimbursed by 80% according to regulations.
Thirdly, we will continue to expand the scope of personal account payments. In order to facilitate the citizens to do a good job in self health management, in addition to medical masks and COVID-19 antigen detection reagents, 32 kinds of instruments and consumables commonly used by citizens, with high demand, good safety and strong applicability, can be purchased by the insured in designated pharmacies with personal account funds. Members of the Family Mutual Aid Network can also use family mutual aid funds to purchase at designated pharmacies in accordance with regulations.
The fourth is to open up designated pharmacies for outpatient reimbursement, making it convenient for the public to dispense medication. The cost of purchasing drugs listed in the medical insurance catalog from designated retail pharmacies that have opened outpatient coordination services, with electronic prescriptions from designated hospitals, will be included in the outpatient coordination reimbursement scope for employee medical insurance and resident medical insurance insured personnel. The outpatient payment policy will be the same as that of prescribing medical institutions.
In addition, the personal account funds of insured individuals for the 2023 medical insurance year will be credited on July 1st. According to the requirements of relevant national and local documents, the personal account inclusion standard for retirees is consistent with the 2022 medical insurance year, with 1680 yuan for those under 74 years old and 1890 yuan for those over 75 years old; 2% of the personal contributions of in-service employees are fully credited to their personal accounts, while the portion paid by the company is fully credited to the overall fund. The funds remaining in the original personal account are still owned and used by the individual.
The Municipal Medical Insurance Bureau reminds that for specific content and related standards on annual conversion of medical insurance, you can log in to the medical insurance website http://ybj.sh.gov.cn Search or call the medical insurance consultation service hotline at 12393.
