关于医保新政相关情况的进一步说明
近日，我市医保新政的出台引发了社会关注和讨论，部分参保群众因对新政理解不全面，如“医保新政对到达法定退休年龄且正在个人缴交补充医疗保险的人员影响和建议”等相关消息在部分微信群、微信朋友圈传播。为向社会公众全面、正确解读医保政策，现将相关情况进一步说明如下：
《东莞市医疗保障办法》（东府〔2023〕60号）将于2024年1月1日起实施。由于贯彻落实省有关统账结合职工医保缴费最低标准的规定，政策实施后，现参加“职工基本医疗保险+住院补充医疗保险”的人员（包括网传“目前每月交29.13元医疗保险费的退休人员”、“每月交189.12元医疗保险费的退休人员”），其实际缴费略有增加。为减少对该类参保人的影响，此次改革我局进行了相应的政策过渡衔接，同步提升了该类参保人的医疗保障待遇水平。 一方面，做好费率过渡性衔接。实际上，疫情期间住院补充医疗保险实施阶段性降费措施，参加“职工基本医疗保险+住院补充医疗保险”的人员缴费费率降费后现为3.3%，但阶段性降费措施将于2023年年底到期，到期后将恢复至原来的政策费率4.8%。按照医保新政，该类参保人政策费率为5.5%；为做好过渡衔接，我局拟于2024年1月起实施阶段性过渡衔接措施，费率减低至4.8%，与前面所说的原政策费率4.8%是一致的。 另一方面，同步提升住院及门诊医疗保障待遇水平。一是住院起付标准降低50%，支付比例增加5个百分点；二是医院就医普通门诊年度最高支付限额增加100%，即2024年医院就医普通门诊年度最高支付限额可增至1874元，支付比例增加5个百分点；三是门诊特定病种基本医疗费用年度最高支付限额增加20%；四是已办理异地就医备案的参保人，其异地就医普通门诊年度最高支付限额增加20%；五是缴费满年限（男30年、女25年）的，不再需要缴纳医保费，且可新建立个人账户，每月按149.91元划入，直至终生。
参保人如对政策有疑问的，可致电咨询热线12345或前往医保经办机构窗口咨询。
东莞市医疗保障局
2023年12月20日
About Further Explanation of the New Medical Insurance Policy
Recently, the introduction of our city's new medical insurance policy has attracted attention and discussion from the public. Some insured individuals have misconceptions about the new policy, and information such as its impact on individuals reaching the statutory retirement age and currently paying for supplementary medical insurance is spreading in some WeChat groups and moments.
To provide a comprehensive and accurate interpretation of the medical insurance policy to the public, the following clarification of relevant information is provided:
The "Dongguan Medical Security Measures" (Dongfu [2023] No. 60) will be implemented from January 1, 2024. Due to the implementation of the provincial regulations regarding the minimum standard for combining the accounts with employee medical insurance contributions, after the policy is implemented, individuals participating in "Employee Basic Medical Insurance + Inpatient Supplementary Medical Insurance" (including rumors about retirees paying a medical insurance fee of 29.13 yuan per month or 189.12 yuan per month) will experience a slight increase in actual contributions. To minimize the impact on such insured individuals, our bureau has made corresponding policy transition adjustments and simultaneously increased the medical security benefits for this group of insured individuals.
On one hand, we have managed the transitional connection of rates. During the epidemic, there was a temporary reduction in the inpatient supplementary medical insurance contribution rate for individuals participating in "Employee Basic Medical Insurance + Inpatient Supplementary Medical Insurance" to 3.3%. However, this temporary reduction will expire at the end of 2023, and after expiration, it will revert to the original policy rate of 4.8%. According to the new medical insurance policy, the contribution rate for this group of insured individuals is 5.5%. To facilitate a smooth transition, our bureau plans to implement a phased transitional connection measure from January 2024, reducing the rate to 4.8%, consistent with the original policy rate of 4.8%.
On the other hand, we have simultaneously increased the level of inpatient and outpatient medical security benefits. First, the inpatient deductible standard is reduced by 50%, and the payment ratio is increased by 5 percentage points. Second, the maximum annual payment limit for general outpatient treatment in hospitals is increased by 100%, allowing the maximum annual payment limit for general outpatient treatment in 2024 to increase to 1874 yuan, with a 5 percentage point increase in the payment ratio. Third, the annual maximum payment limit for basic medical expenses for outpatient treatment of specific diseases is increased by 20%. Fourth, for insured individuals who have registered for medical treatment in other places, the maximum annual payment limit for general outpatient treatment in other places is increased by 20%. Fifth, for those who have paid for the full period (30 years for men, 25 years for women), there is no need to pay medical insurance premiums anymore, and a new personal account can be established, with 149.91 yuan transferred into it monthly until the end of life.
Insured individuals with questions about the policy can call the consultation hotline 12345 or visit the medical insurance handling agency for inquiries.
Dongguan Medical Security Bureau December 20, 2023
