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Dear patient,

Welcome to Yizhou Cancer Hospital. In order to facilitate your medical insurance registration and reimbursement, we will inform you of the documents and precautions you need to carry.

Within three days of admission, you should register online at the medical insurance window on the first floor with the medical insurance registration review form, social security card, ID card and household registration book (provided by Zhuozhou urban and rural residents) filled in by the attending physician, and keep the patient's social security card in the medical insurance window. Patients are not allowed to leave the hospital during hospitalization, and are not allowed to stay in the hospital at any time through random checks.

After the discharge notice under the ward, the patient or family member shall go to the inpatient office on the first floor with the deposit slip for discharge settlement. After the settlement, the patient shall go to the medical insurance window for reimbursement with the settlement documents, diagnosis certificate (issued by the attending physician), ID card and bank card. After the reimbursement is completed, please go to the discharge window for invoice issuance.

If you have any medical insurance related questions, please call 010-50843897 or go to the medical insurance window on the first floor for consultation.

Medical insurance related policy

1. Our hospital is a designated medical institution for national medical insurance, and all patients with national medical insurance can be reimbursed for hospitalization in our hospital. (Specific reimbursement rates refer to local medical insurance policies).

2. Cancellation of the record for medical treatment in different places in Hebei Province.

According to the Hebei Medical Security Bureau issued the "Notice on standardizing the Basic Medical Insurance long-distance medical treatment Policy in the Province to achieve no difference in the Province", in order to continue to deepen the reform of medical security "decentralization service", promote the sharing of high-quality resources in the province, facilitate the insured masses in the province of long-distance medical treatment policy, achieve no difference in the province of direct settlement of medical treatment, cancel all provincial long-distance medical records. Insured personnel can select designated medical institutions and designated retail pharmacies for direct settlement of hospital and outpatient costs that have been opened in all coordinating areas of the province according to the regulations, and there is no need to record, so as to achieve direct settlement of long-distance medical treatment in the province.

Scope of personnel security

Employees participating in basic medical insurance (including maternity insurance) and basic medical insurance for urban and rural residents in the planning areas of Hebei Province.

Scope of policy implementation

The medical expenses within the scope of the policy incurred by the insured personnel in the medical institutions that have opened inpatient or outpatient medical insurance designated points in other coordinating areas of the province outside the insured place, outpatient medical treatment and drug purchase in pharmacies.

The payment scope and standards stipulated by the place of medical treatment in the province (basic medical insurance drug list, diagnosis and treatment items, scope and standards of medical service facilities); The starting payment standard, payment proportion, maximum payment limit and other policy provisions of the medical insurance fund shall be implemented, and the treatment policies and settlement methods of the insured places shall be implemented.

Hospitalization policy

For medical treatment in other coordinating areas in the province, the minimum payment line will no longer be raised, the reimbursement ratio will be reduced, and the policy of equal treatment for medical institutions of the same level will be implemented. The basic medical insurance, serious illness insurance and personal account expenses incurred in all designated hospital medical institutions in the province can be settled directly.

General outpatient coordination policy

The direct settlement of remote general outpatient clinics in the province limits the level 2 and above designated medical institutions in the province, cancels the limit on the number of outpatient coordination points in each coordinating area, and the level 2 and above designated medical institutions in the province can use the outpatient coordination and personal accounts for direct settlement. The coordinating points of designated medical institutions and retail pharmacies below the second level shall be determined by each coordinating area.

Outpatient chronic (special) illness policy

Outpatient chronic (special) diseases shall be subject to the unified disease codes of the insured places and the State Medical Security Administration. The direct settlement of chronic (special) diseases in remote outpatient clinics in the province is limited to second-level and above designated medical institutions in the province, the number of designated outpatient chronic (special) diseases in each coordinating area is cancelled, and the designated medical institutions at second-level and above the province can use basic medical insurance and personal accounts to settle directly, and the designated medical institutions below the second-level and designated retail pharmacies are determined by each coordinating area. The outpatient medication protection policy for urban and rural residents with hypertension and diabetes is limited to second-level and below designated medical institutions at the time of direct settlement in remote outpatient clinics.

Pharmacy purchase policy

The direct settlement of employee medical insurance personal accounts in different places in the province shall implement the scope of use prescribed by the state, and can be used by designated retail pharmacies in the province.

Background and basis analysis of the policy adjustment of employee medical insurance

First, adjust the base of employee medical insurance contributions

In 2019, the "Notice on Adjusting the Contribution base of Employee Medical Insurance (including maternity insurance)" issued by the four provincial departments requires that "since 2019, the average wage of employees in full-caliber urban units is lower than the average wage of employees in full-caliber urban units, and the average wage of employees in full-caliber urban units is higher than the average wage of employees in full-caliber urban units." Contributions are based on actual wages ". However, at the same time, it stipulates that "enterprises with difficulties, flexible employment personnel and other groups with special difficulties stipulated by each city shall determine the payment base and lower limit by each city to ensure that the payment burden of enterprises is not increased." Accordingly, in order to reduce the personal burden of employers and insured personnel, with the consent of the municipal government, the city's payment base follows the historical policy, which stipulates that "difficult enterprises, flexible employment personnel and people who are lower than 60% of the average wage of employment personnel in the city's full-caliber urban units, the lower limit of the payment base is 60%".

The adjustment of the payment base is carried out in accordance with the arrangement and deployment of the superior, and the overall planning areas of the province are unified. The main reason is that the policy has made clear provisions: In 2021, the Hebei Medical Security Bureau and the Hebei Provincial Department of Finance issued the "Implementation Opinions on the Implementation of the National Medical Security Treatment List System", proposing that "it must be implemented in strict accordance with the relevant provisions of the treatment list, shall not introduce policies beyond the scope of the list of authorization, and those that do not conform to the requirements of the list shall be combed and self-checked and cleaned up." The treatment list and the "Guiding Opinions on Further Improving the Municipal pooling of Basic Medical Insurance for Employees" issued by the Hebei Medical Security Bureau, the Hebei Provincial Department of Finance, and the Hebei Provincial Tax Bureau of the State Administration of Taxation all stipulate that "the individual payment base of basic medical insurance for employees shall be verified according to the average salary of employed persons in all urban units in the pooling area. If the average wage of employed persons in all-caliber urban units is lower, the average wage of employed persons in all-caliber urban units shall be taken as the payment base; if the average wage of employed persons in all-caliber urban units is higher, the actual wage shall be taken as the payment base. Flexible employment shall be based on the average salary of employed persons in all urban units in the overall planning area." Second, the higher authorities put forward clear requirements: the provincial medical insurance department specifically requested the municipal medical insurance department to "strictly implement the policy of the national and provincial payment base, and shall not set the lower limit of 60% payment base." The third is the restriction of the national medical insurance information platform. According to the unified arrangement and deployment of the superior, the provincial medical insurance information system has switched to the national unified medical insurance information platform, and the policy of setting the payment base separately does not meet the requirements of the new system and does not have the conditions for setting.

In view of this, in order to strictly implement the unified requirements of the state and the province, standardize the medical insurance policy of our city, and adapt to the actual operation of the new system, since January 1, 2022, the payment base of employee medical insurance has been adjusted, and the lower limit of the 60% minimum payment base has been cancelled.

Second, adjust the transfer standards of employee medical insurance personal accounts

In accordance with the relevant requirements of the "Guiding Opinions of The General Office of the State Council on Establishing and improving the Mutual assistance mechanism for Employees' Basic Medical Insurance Outpatient Service" and the "Notice of the General Office of the Hebei Provincial People's Government on Establishing and improving the implementation Measures for the mutual assistance mechanism for Employees' Basic Medical Insurance Outpatient Service", the transfer method of individual accounts is reformed. The transfer base of the in-service personnel is the insurance payment base of their own, and the transfer proportion is 2%; The transfer method for retirees of government agencies and public institutions is adjusted to 2% of the average basic pension level of retirees of government agencies and public institutions in Baoding in 2021, and the transfer method for retirees of enterprises is adjusted to 2% of the average basic pension level of retirees of enterprises in Baoding in 2021. After adjusting the transfer method of personal accounts, the money transferred to the personal accounts of some insured people will be reduced.

This time, through the reform of the employee medical insurance personal account, the medical insurance fund replaced after the reduction of the personal account is used to establish the general outpatient pooling system, the outpatient expenses within the scope of the policy are included in the medical insurance coverage, the outpatient reimbursement treatment is increased, and the outpatient mutual support function is enhanced. After the personal account reform, the previous personal accumulation is still owned by the individual, and the new amount of the insured will be reduced accordingly from 2022. But at the same time, the insured can enjoy the general outpatient reimbursement policy. Reducing part of the amount does not mean that the insurance of the insured will be lost, but it will be placed in the large pool of mutual protection, forming a new outpatient overall protection mechanism, and generally achieving the balance transfer of the fund and enlarging the protection efficiency.

Third, the establishment of general outpatient coordination system

In accordance with the relevant requirements of the "Guiding Opinions of The General Office of the State Council on Establishing and improving the Mechanism of mutual assistance for Employees' Basic Medical Insurance Outpatient Service" and the Notice of the General Office of the Hebei Provincial People's Government on Establishing and improving the implementation Measures of the Mechanism of mutual assistance for Employees' Basic Medical Insurance Outpatient Service ", the outpatient expenses within the scope of the policy are included in the reimbursement scope of the overall planning fund to enhance the guarantee function of the medical insurance fund. Improve the efficiency of the use of the fund, and improve the accessibility of outpatient medical services accordingly. From January 1, 2022, the city has implemented the general outpatient pooling system. The insured personnel can enjoy medical insurance reimbursement treatment in the outpatient department of designated medical institutions. The minimum payment standard is 100 yuan/year, and the reimbursement ratio of in-service employees for expenses within the scope of the policy above the minimum payment standard is 50%, and the maximum limit is 900 yuan/year; The reimbursement rate for retired employees is 60%, and the maximum limit is 1,200 yuan/year. The level of outpatient treatment in the province in the middle. Because the outpatient pooling system is a new system, after running for a period of time, we will analyze and calculate in a timely manner according to the fund expenditure, timely adjust the reimbursement ratio and the maximum payment limit, and gradually improve the treatment level.