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Q&A on Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism (Draft for Comment)

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On August 26, 2020, the National Medical Security Administration issued the "Guiding Opinions on Establishing and Improving the Employee Basic Medical Insurance Outpatient Mutual Aid Guarantee Mechanism (Draft for Solicitation of Comments)" to solicit opinions from the public. So, what are the guiding opinions in the draft?

Q:
What are the improvements regarding outpatient medical expenses reimbursement?
A: Outpatient chronic diseases such as hypertension and diabetes are also included in the payment scope of the overall fund.

Q:
What is the payment ratio of the insured person?
A:
General outpatient clinics cover all employees who are covered by medical insurance, and the payment ratio starts from 50%. As the affordability of the fund increases and the level of protection is gradually increased, the payment of benefits can be appropriately inclined to retirees.

Q:
Are there any adjustments to the personal account crediting method?
A:
At present, 30% of the basic medical insurance premium paid by the employer and 2% of the individual paid are included in the personal account. After the adjustment, only 2% of the department paid by the individual will be included in the personal account, and all the part paid by the employer will be included in the overall plan.

Q:
What is the proportion of retirees’ personal accounts included?
A:
In principle, the personal accounts of retirees are allocated from the overall planning fund at a fixed amount, and the allocated amount is calculated based on about 2% of the basic pension at the time of the reform of the region, and will not be adjusted in future years.

Q:
Is there any change in the use of personal accounts?
A:
Personal accounts can be used to pay for medical expenses incurred by the employees themselves, their spouses, parents, and children in medical insurance designated medical institutions, and the expenses incurred by individuals for purchasing drugs and medical consumables in designated retail pharmacies.

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