From January 1, 2024, the "Dongguan Medical Security Measures" will be officially implemented. At present, it has been a while since the implementation of the new medical security measures, and some netizens are still unclear about the new standard for employee medical insurance payment in 2024, so let's find out together today!
In 2024, the new standard for employee medical insurance payment
On January 1, 2024, the Measures for Medical Security in Dongguan (hereinafter referred to as the "Measures") will be implemented, which stipulates that the basic medical insurance for employees in Dongguan (hereinafter referred to as the "Employee Medical Insurance") in Dongguan includes the unified account combined with the employee medical insurance and the single construction of the overall employee medical insurance, and the supplementary medical insurance includes the serious illness insurance and the subsidy for large medical expenses of employees (hereinafter referred to as the "large subsidy"). The following is an introduction to the insurance rules of each type of insurance, the connection between the old and new methods and the payment standards.
Rules for Employee Medical Insurance
1.The employer chooses to participate in the unified account combined with the employee medical insurance or the single construction of the overall employee medical insurance on a unit-by-unit basis;
2.Flexible employment personnel and other personnel shall be selected by the individual to participate in the unified account combined with the employee medical insurance or the single construction of the overall employee medical insurance;
3.Units that choose to participate in the unified account combined with employee medical insurance can choose not to establish a personal account for all or part of their personnel.
Rules for Participation in Large Grants
1.Those who participate in the city's unified account combined with employee medical insurance can choose to participate in the large-amount subsidy for the employer as the unit;
2.Other personnel such as flexible employment personnel who participate in the city's unified account combined with employee medical insurance shall be selected by individuals to participate in large-amount subsidies;
3.Personnel who have not participated in the city's unified account combined with employee medical insurance shall not participate in the large subsidy alone.
Critical illness insurance participation rules
Participants who participate in the city's basic medical insurance shall also participate in serious illness insurance. Employers and insured persons do not have to pay separately for critical illness insurance.
The old and new methods are connected
1.Originally, those who only participated in basic insurance were connected to participating in the single-construction co-ordination of employee medical insurance;
2.Those who originally participated in basic insurance + hospitalization supplementary insurance were connected to participate in the unified account combined with employee medical insurance (no individual account) + large subsidies for employees;
3.Those who originally participated in basic insurance + hospitalization supplementary insurance + personal account were connected to participate in the unified account combined with employee medical insurance (with an account) + large subsidies for employees.
2024 payment standards for each type of insurance
Common misunderstandings of employee medical insurance payment in 2024
Myth 1: Can't you get much reimbursement for medical insurance? Is it a waste of money for young people to enroll in insurance? Medical insurance can only be used locally, not overseas? Is it useful to be insured?
Interpretation:Judging from the medical data, in 2022, the medical insurance treatment of employees will be 210.4 billion person-times, and residents enjoy medical insurance treatment of 215.7 billion person-times, an increase over the previous year. The number of hospitalizations covered by medical insurance accounts for about 88% of the total hospital admissions. The reimbursement data really reflects the medical needs of the medical insurance system for the insured, whether it is employee medical insurance or resident medical insurance, the "majority" of hospitalization expenses are paid by medical insurance**. The increase in the number of people receiving benefits reflects the sense of gain of the insured.
From the perspective of medical insurance policies and measures, the insured can enjoy a number of medical insurance benefits such as general outpatient co-ordination, outpatient specific disease protection, outpatient medication protection for two diseases, separate payment, hospitalization protection, remote medical treatment, emergency, rescue, serious illness insurance, medical assistance, etc. In addition, household registration restrictions will be lifted, and flexibly employed persons can also participate in employee medical insurance; Support insured patients to seek medical treatment in primary medical institutions, and the reimbursement ratio is higher. The benefits of being insured go far beyond these ......The risk of disease is difficult to predict, and only timely and continuous insurance can prevent and resolve the risk of medical expenses.
Myth 2: Will the overall medical insurance quota be cleared by the end of the year? If you don't spend it, it's a waste?
Interpretation:Recently, "medical insurance outpatient co-ordination will not be reimbursed until the end of December" and "there will be no outpatient co-ordination policy next year!" Several other rumors about health insurance spread on the Internet. "Treatment deadline" and "policy cancellation" are pure rumors, and "no need to use in vain, zero at the end of the year" is a misunderstanding and misreading of the medical insurance policy.
The outpatient co-ordination treatment standard is that within a medical insurance year, the outpatient medical expenses incurred by the insured persons within the policy scope of the designated medical institutions shall be settled according to the policy. In 2024, the outpatient expenses of insured employees will be re-accumulated, and they will enjoy the outpatient co-ordination treatment according to the regulations after reaching the minimum payment standard. Therefore, there is no such thing as "clearing", "waste", "money refunded if it is not used up", and there is no "treatment cut-off" and "policy cancellation".
We hereby remind the majority of insured people not to believe in rumors, not to spread rumors, to rationally seek medical treatment and purchase drugs according to the actual situation, not to use medical security certificates to purchase daily necessities and health products, not to exchange non-medical insurance and non-special drugs for medical insurance and special drugs, not to hand over their medical security certificates to others to use or use other people's medical security certificates, and not to take advantage of the opportunity to enjoy medical security treatment to resell drugs, accept cash returns in kind or obtain other illegal benefits, etc. Once the above acts are verified, illegal gains will be recovered, and if the circumstances are serious, they will be handed over to the judicial organs for handling.
Myth 3: Does the medical insurance department have a limit on the number of days of hospitalization for insured patients? After 10 or 15 days, do you want to be discharged and re-hospitalized?
Interpretation:The medical insurance department has never had any restrictions on the number of days of hospitalization, the number of hospitalizations and the cost of hospitalization for insured patients. Whether an inpatient can be discharged from the hospital is decided by the doctor based on the patient's ** condition. Designated medical institutions shall strictly grasp the admission and discharge standards in accordance with regulations, and shall not refuse to accept insured persons who meet the conditions for hospitalization, and shall not require insured persons who do not meet the discharge standards to be discharged from the hospital in advance. If the situation is verified to be true, it will be handled in accordance with the agreement and relevant regulations. If the patient encounters the situation of being decomposed into hospitalization or forced discharge, he or she can complain to the medical insurance department of the designated medical institution or the local medical insurance department.
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