China health insurance to see increased reimbursement level

No change in the attribution of personal accounts

China health insurance to see increased reimbursement level

Insurance News

By Kenneth Araullo

As part of China’s ongoing health insurance reform, an official of the country’s National Healthcare Security Administration (NHSA) said that it will offer more benefits to insured people such as increased reimbursement of general outpatient bills. That said, the attribution of personal accounts will not change.

Industry analysts noted that the ongoing reform does not mean any curtailment of benefits for insured people. This will utilize funds from personal accounts more efficiently, especially for the elderly, who normally incur higher medical expenses.

The official responded to public concerns regarding the reduced amount deposited each month into personal accounts, saying that the reform’s intention is to adjust the contribution from employers to personal accounts as a means of replacement to support the reimbursement of general outpatient bills.

More areas are also expected to be covered under the outpatient reimbursement reform, while increasing levels for already covered areas. Payments made by employees will still flow into each holder’s personal accounts; retirees, on the other hand, do not need to pay for personal accounts.

For employees, funds deposited by employers into personal accounts will be directly paid to the pooled fund for outpatient reimbursement instead of personal accounts. Retirees’ deposits will be adjusted based on the changes of standards.

Adjustment of benefits

According to the report, China’s health insurance system includes mandatory personal accounts with contributions from both employees and employers. These mainly pay for ordinary outpatient services and consist of a pooled fund contributed by employers. This fund is used to reimburse hospitalization bills, outpatient bills for serious illnesses, and expenses for chronic diseases.

The reform will involve the adjustment of benefits, said the NHSA official. Many participants will see different degrees of reduction in the funds allocated to their personal accounts, with authorities stepping up their efforts to promote policy convergence before and after the reform.

Central China Normal University department of labor and social security associate professor Wang Chaoqun described the new outpatient reimbursement arrangement as enhancing the benefits for insured people through better utilization of the fund rather than the cutting of benefits. Chaoqun also said that many elderly people have a higher demand for outpatient services, but these expenses can’t be covered by the fund from personal accounts. On the other hand, funds in the accounts of people who have less of a need for immediate medical treatment may remain idle.

Outpatient bills reimbursement

The ongoing reform raises the minimum reimbursement percentage for outpatient medical bills to 50%. It will also be part of efforts to further tip the scales of policy in favor of retired people.

Of note are the retirees in Hohhot, North China’s Inner Mongolia Autonomous Region. Insureds here can have up to CNY6,000 ($870) of their outpatient bills reimbursed, an increase of CNY2,000. Hohhot added 5% to the standard reimbursement ratio of outpatient bills for retired people while raising the upper limit for the collective fund to cover their outpatient bills.

The reform is also expected to further utilize medical resources, target difficulties in getting hospital treatment, and expand the usage of personal accounts to family members.

Chinese insurers Huize and Guolian Life recently launched a new product called “Xiao Tao Qi No.1,” a comprehensive and cost-effective critical illness insurance product customized for meeting children’s protection needs.

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