1. Establish and improve the outpatient co-ordination of employee medical insurance;
2. Establish a new outpatient co-ordination policy, optimize and integrate the original outpatient co-ordination and outpatient chronic disease policy of employee medical insurance, and merge them into a new outpatient co-ordination policy to realize the transformation from basic medical insurance disease protection to cost protection, and improve the fairness and accessibility of outpatient security treatment;
3, improve the level of outpatient treatment, increase outpatient special diseases, the diagnosis is clear, the condition is relatively stable, the cost burden is relatively heavy, and the diseases suitable for outpatient treatment are included in the scope of outpatient special diseases of employee medical insurance, from the original four types of special diseases to nine types, * * *13;
4. Adjust the personal account included in the policy, establish an outpatient personal account, and extract it from the total salary according to a certain proportion every month and transfer it to the personal account to pay the outpatient medical expenses incurred by the insured in designated medical institutions;
5. Establish a health management service package, incorporate the health examination contents in basic public health services into the overall planning of employee medical insurance outpatient service, and increase medical examination items to promote the normalization and standardization of outpatient health management services;
6, standardize the medical insurance outpatient special disease protection, strengthen the supervision of special diseases, standardize the audit and settlement process of special diseases, and ensure the implementation of special disease protection policies;
7, increase outpatient medical services, expand the scope of outpatient medical services, increase the number of medical service institutions, facilitate the insured to seek medical treatment nearby, and improve the quality of medical services;
8. Strengthen the management of medical insurance funds, improve the fund budget and control mechanism, strengthen the supervision and management of medical insurance funds, and ensure the rational use and safe operation of funds;
9. Promote information construction, strengthen the construction of medical insurance information platform and information sharing, and improve the efficiency and accuracy of medical insurance management;
10, strengthen publicity and training, strengthen the publicity and interpretation of employee medical insurance policies, and improve the awareness and compliance of insured personnel and medical staff on medical insurance policies.
Matters needing attention in medical insurance for Nanjing employees in 2023 are as follows:
1. It is suggested to choose the nearest designated medical institution to avoid increasing the cost of cross-regional medical treatment;
2. Please do a good job of nucleic acid detection before seeing a doctor, so as to see a doctor smoothly and avoid the risk of epidemic prevention;
3. Please bring your medical insurance card (social security card), ID card and other valid documents to see a doctor, so as to settle the medical expenses smoothly;
4. For patients with past diseases, please bring relevant diagnosis certificates and prescriptions issued by doctors in order to reimburse medical expenses;
5. Please keep medical insurance cards, prescriptions, invoices and other related medical materials properly for reimbursement;
6. If you need special treatment or purchase over-the-counter drugs, please consult a doctor in advance and follow the doctor's advice to avoid unnecessary expenses;
7. If it is inconvenient to see a doctor or if COVID-19 is suspected, please call the hospital for consultation or consult the hospital for diagnosis.
8. During the epidemic prevention and control, please do personal protection, wear masks, wash your hands frequently, keep social distance, avoid gathering, and wait for close contact again after the epidemic.
To sum up, the above are some precautions for medical insurance for employees in Nanjing, and it is necessary to carry out actual operations or consult relevant departments according to their own conditions to obtain more detailed and accurate information.
Legal basis:
Article 23 of People's Republic of China (PRC) Social Insurance Law
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.