During the epidemic, the hot questions of Hainan medical insurance policy have been answered!

During the epidemic period, the medical security department of Hainan Province adopted a combination of online and offline acceptance methods to ensure the uninterrupted medical insurance benefits of the people, and at the same time implemented the policies issued by the National Medical Security Bureau to provide convenience for medical institutions and patients. Recently, Hainan Provincial Medical Insurance Bureau has sorted out the hot issues of medical insurance policy during the epidemic and answered them in detail.

Patient article

Question 1: For COVID-19 patients, did the doctor use drugs that are not covered by medical insurance or are beyond the indications according to the COVID-19 diagnosis and treatment plan issued by the state, and was it paid by medical insurance?

A: It is paid by medical insurance. According to the spirit of the relevant documents of the National Medical Insurance Bureau, all drugs listed in the COVID-19 diagnosis and treatment plan issued by the state can be temporarily included in the scope of medical insurance payment, even if they are not within the scope of the medical insurance drug list or beyond the indications.

Question 2: Do individuals need to bear part of the medical expenses incurred by the diagnosed, suspected patients and asymptomatic infected people in COVID-19?

A: No need to bear, "zero pays". After the medical expenses incurred by the insured patients are paid in accordance with the regulations, such as basic medical insurance, serious illness insurance and medical assistance, the personal burden will be subsidized by the finance. Uninsured patients are allowed to pay the basic medical insurance for urban and rural residents and enjoy the basic medical insurance benefits for urban and rural residents.

Question 3: How to settle the medical expenses of confirmed patients, suspected patients and asymptomatic infected people who seek medical treatment in different places?

A: First treat and then settle. The expenses paid for medical insurance in different places shall be paid in advance by the medical insurance department of the place of medical treatment, and the expenses paid in advance shall be included in the national settlement of medical expenses in different places, and the personal part shall be borne by the finance of the place of medical treatment according to regulations.

Medication article

Question 1: Hainan Province stipulates that outpatients with chronic and special diseases can only designate two designated medical institutions for medical treatment and medicine. However, due to the epidemic situation, some hospitals may not be able to open clinics normally during the epidemic period, which makes it very inconvenient for some patients to get medicine or treatment. How to solve this problem?

A: During the epidemic period, the restriction that only two designated medical institutions with medical insurance can be selected for outpatient medication or treatment of patients with chronic and special diseases is cancelled. Outpatients with chronic and special diseases can take medication or treatment in all designated medical institutions with medical insurance in the province.

Question 2: According to the requirements of epidemic prevention and control, in order to reduce the spread of the epidemic and prevent nosocomial infection, the masses should go to the hospital as little as possible in principle. Can people who have long-term medication for chronic and special diseases dispense more drugs at one time?

A: In order to better serve the needs of current epidemic prevention and control and reduce the risk of infection of insured patients seeking medical treatment, Hainan Provincial Health Insurance Bureau timely adjusted and issued relevant policies, stipulating that patients with chronic special diseases in outpatient clinics with stable conditions can prescribe outpatient drugs for up to 90 days, that is, three months, after evaluation by doctors in designated medical institutions, which greatly meets the needs of such patients.

Vaccine article

Question 1: Who will pay for the cost of vaccines and vaccination in COVID-19?

A: COVID-19’s vaccine and vaccination expenses are borne by the medical insurance fund, and the financial department gives appropriate subsidies according to the actual expenses. That is to say, Covid-19’s vaccine and vaccination are paid by the medical insurance fund and finance, and individuals do not bear any expenses.

Question 2: Judging from the number of people vaccinated in our province at present, the amount of funds for ensuring vaccines and vaccination expenses in COVID-19 is very large. Can the medical insurance fund bear it?

A: Since the new crown vaccine and vaccination expenses were guaranteed, the Hainan Provincial Health Insurance Bureau has continued to advance the vaccine funds, which can meet the needs of residents in our province to vaccinate COVID-19 vaccine in this round, and has completely achieved the goal of "money is equal to seedlings".

It is a special measure to pay for COVID-19 vaccine by medical insurance in response to special events. The accumulated balance of medical insurance fund is mainly used, which will not affect the income and expenditure of medical insurance fund in the current period, nor will it affect the people’s enjoyment of medical insurance benefits.

Question 3: Can people who have not participated in medical insurance or foreign household registration be vaccinated or vaccinated nearby?

A: On the premise of the informed consent of the recipients, Chinese residents can go to any vaccination institution designated by the local health department for vaccination according to the regulations only by holding the resident ID card, regardless of whether they participate in medical insurance or whether they are local household registration.

Question 4: Do foreigners need to pay for COVID-19 vaccination?

A: Foreigners who have participated in the basic medical insurance in our province can be vaccinated with COVID-19 vaccine for free; Foreigners who have not participated in the basic medical insurance in our province are vaccinated according to the principle of "informed, voluntary and self-funded".

Payment article

Question 1: During the epidemic, did the medical insurance formulate measures to help enterprises out?

A: Since the outbreak, Hainan Provincial Health Insurance Bureau has timely issued relevant policies such as deferring and reducing medical insurance premiums to help enterprises effectively reduce their burdens and tide over the difficulties. For example, this year’s document clearly stipulates that from July to September, 2022, small and medium-sized enterprises and individual industrial and commercial households in the province, as well as social organizations such as social organizations, foundations, social service institutions, law firms and accounting firms, will be deferred to pay the unit payment part of the basic medical insurance (including maternity insurance) for three months, and the late payment fee will be exempted during the deferred payment period, and the insured person’s treatment should be enjoyed.

Question 2: During the epidemic period, can the collection period of medical insurance premium be extended?

A: Extend the collection period. First, in August 2022, the reporting period for employees’ insurance registration was adjusted from August 1st to August 25th to August 1st to August 30th. During the epidemic period, the insured units can’t declare and pay the medical insurance fees normally, and if they declare and pay the medical insurance fees before September 30, no late payment fee will be charged. If the payment is completed before September 30, 2022, it will be regarded as normal payment, and the medical insurance benefits during the period will not be affected. Second, urban and rural residents’ medical insurance participants failed to apply for insurance and pay the medical insurance premium for urban and rural residents in 2022 in time in August, 2022, and completed the payment before September 30, 2022. Among them, newborns who did not exceed 90 days (including 90 days) were insured and paid within the prescribed time limit, and enjoyed the medical insurance benefits for urban and rural residents in the current year and the next year according to regulations from the date of birth; The rest will enjoy the medical insurance benefits for urban and rural residents in the current year from August 1, 2022.

Question 3: Can medical insurance payment be done online?

A: Yes. Declare payment through Hainan social security and medical insurance public service platform official website, Hainan medical insurance APP and other channels.

Reimbursement article

Question 1: during the epidemic, I didn’t go to the handling hall to go through the reimbursement procedures. Can I still reimburse in the future?

A: Medical expenses can be deferred for reimbursement. Due to the suspension of window service in the static control area during the epidemic period and the inability of the insured people to handle business in the handling service hall, the handling agencies in the static control area will extend the business acceptance time to September 30, 2022 (except holidays, and the subsequent extension will be notified separately by the handling agencies at all levels according to the local epidemic control situation).

Question 2: Are there any requirements for handling business in the handling hall?

Answer: Before entering the handling service hall, you must cooperate with the staff to take temperature measurement at the entrance, take the initiative to sweep the floor, show your health code and travel code, provide negative proof of nucleic acid test (the specific situation is subject to local control requirements), and wear masks regularly throughout the whole process before entering the hall for business. Encourage online business through "online office" and "handheld office". (Reporter Sun Hui Intern Zhang Ziwei)