authoritative release: "weinibao 2024" version is released online!
2024-09-02
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on september 2, the weihai municipal government information office held a press conference. li kai, member of the party leadership group of the municipal medical insurance bureau and director of the municipal medical insurance center, tian hongyao, member of the party leadership group of the municipal civil affairs bureau, fourth-level researcher and spokesperson, wang hongxian, deputy director of the weihai financial regulatory branch, and wang shengjin, fourth-level senior host of the weihai municipal taxation bureau and chief of the corporate income tax section, introduced the relevant situation of weihai’s customized commercial medical insurance - "wei ni bao 2024".
in order to make up for the shortcomings of the medical insurance system and better improve the medical insurance benefits of the people, weihai city launched a customized commercial medical insurance - "weinibao" earlier in the province since 2021. in the past three years, a total of 1.25 million people have been insured, and a total of 42,700 people have reduced their medical expenses by more than 100 million yuan, with the highest cumulative compensation for a single person being 1.45 million yuan. this year, based on a careful summary, the product was comprehensively upgraded and improved, and a new version of "weinibao 2024" was launched, which was released on the day of the press conference.
product features are more prominent
the "weinibao 2024" version is a more favorable customized commercial medical insurance product that has been improved based on an in-depth summary of the operation of the previous three phases of products, highlighting the following features:
government support and standardized development. the "weinibao 2024" version of the product is a customized medical insurance product that is guided and supported by the government, operated by the market mechanism, and voluntarily participated by the masses, and effectively connected with the medical insurance system. unlike general commercial insurance products, it is not for profit. it is jointly promoted and regulated by multiple departments such as medical insurance, civil affairs, finance, agriculture and rural areas, health and health, sasac, taxation, financial supervision, trade unions, women's federations, and disabled persons' federations, and has the attributes of a quasi-public product.
guaranteed benefits are linked and complementary to basic medical insurance. "weinibao" is positioned as an important part of the multi-level medical security system. it is based on basic medical insurance, effectively linked to the medical security system, and complementary in function. it includes both the expenses in the medical insurance catalogue and those outside the catalogue into the protection scope, and extends to health management expenses, effectively giving play to the comprehensive protection benefits of the multi-level medical security system.
the principle of benefiting the people is fully reflected. the product adheres to the principle of capital preservation and small profits, and is open to all basic medical insurance participants in our province. there are no restrictions on insurance such as age, health status, previous medical history, and occupation type. the product's financing standards and protection levels are in line with the people's ability to bear, further lowering the threshold for expense reimbursement, continuing to highlight the protection of expenses for major and serious diseases, while increasing health service content and continuously expanding the product's beneficiaries.
comprehensive upgrade of security content
compared with previous years' products, the "weinibao 2024" version has been optimized and upgraded in five aspects: "reduction, increase, benefit, expansion and adjustment":
"reduction" means reducing the deductible for hospitalization within the medical insurance. the compensation liability of the "weinibao 2024" version has four parts. first, for hospitalization expenses within the scope of the medical insurance policy, the deductible has been significantly reduced from 16,000 yuan to 6,000 yuan, and the part from 6,000 yuan to 16,000 yuan will be compensated at a rate of 5%, and the part above 16,000 yuan will be compensated at a rate of 60% to 80% according to the cost segment; second, for hospitalization expenses outside the scope of the medical insurance policy, the deductible remains unchanged at 16,000 yuan, and 20% to 40% will be compensated according to the cost segment; third, it is the only province in the province that includes all ordinary outpatient drug expenses incurred by insured people in designated medical institutions in the coverage, with a deductible of 10,000 yuan and a compensation ratio of 60%. fourth, the cost of special medicines, including 17 kinds of rare diseases, innovative drugs, etc. incurred in designated medical institutions or designated pharmacies, is included in the coverage, and the deductible of 10,000 yuan is shared with the third responsibility, and the compensation ratio is 70%.
"increase" means that the value-added services have been increased to 14. on the basis of retaining the original value-added health services such as outpatient appointments, specific disease risk management, and serious illness project management, the insured can also enjoy new benefits such as interpretation of physical examination reports, free helicobacter pylori (hp) antigen testing, 25% discount on free online consultations and medicine purchases on jd.com, 20% discount on free online consultations and medicine purchases on yifeng, and medicine purchases, dental cleanings, and physical examinations at some local designated medical institutions.
"benefit" means that the premium adjustment is more favorable. only 39 yuan per person per year is required for those aged 22 years and below, which is the lowest in the province. 89 yuan per person per year is required for those aged 22 years and above but below 60 years, and 139 yuan per person is required for those aged 60 years and above. this year, the premium standard for about 29,000 medical assistance recipients in the city before the insurance is opened will be uniformly reduced to 39 yuan. at the same time, the premium standard for the group with a cumulative compensation of more than 2,000 yuan by "weinibao" as of august 31, 2024 will be adjusted to 150 yuan per person per year.
"expand" means expanding the scope of insured persons. "weinibao" is not limited by age, occupation, or health status. as long as you participate in basic medical insurance, you can voluntarily purchase it. veterans and newborns in 2025 can apply for "weinibao" when they participate in basic medical insurance, without being restricted by the insurance period. newborns whose parents are both insured can apply for exemption from insurance to enjoy benefits.
"adjustment" refers to the adjustment of the insurance period and the protection period. the insurance period of the 2024 version of "weinibao" is adjusted from september 2 to december 31, 2024, which is basically the same as the concentrated payment period of the basic medical insurance for residents. the protection period is from january 1 to december 31, 2025, and the reimbursement treatment connection is smoother.
greatly improved service quality
we have deeply created a comprehensive service model combining online and offline services, making insurance more convenient and quick. the insured people can follow the "weinibao" wechat public account to purchase insurance. they can use the balance of their personal accounts to purchase insurance for themselves and their immediate relatives (spouse, parents, children, brothers and sisters, grandparents, grandchildren, and grandchildren), or use wechat, bank card balance, etc. to pay. in addition, when you participate in the insurance this year, you can also choose the "continuous insurance" reminder function, which will automatically remind you to pay the premium in the next year, so that you will not miss the insurance period. the customer service system is more complete. "weinibao" has set up a special "weinibao" service hotline to provide the public with 7×24 hours of uninterrupted service, and uniformly accept and handle the public's policy consultation and service complaints. a special "weinibao" physical customer service center has been set up at the east gate of shangcheng international in the city center, and a "weinibao convenience service point" has been set up in the city's leading hospitals to provide the insured with claims consultation, medical guidance, elderly, weak, sick and disabled care services, claims information collection services, etc. the payment process is simpler. the medical expenses of the insured who are hospitalized in weihai and included in the compensation scope of "weinibao" are settled in a one-stop manner at the medical institution with other medical insurance benefits, without the need to go to the insurance agency for secondary reimbursement, which effectively reduces the pressure on the insured to run errands and advance funds. a new post-compensation visit mechanism has been established, and customer satisfaction and opinions are reviewed at a rate of no less than 5%, continuously improving the claims service.
the optimization of the "wei ni bao 2024" version is another solid step taken by weihai city in building a multi-level medical security system. it will play a more positive role in further improving the medical security level of the people in the city and effectively preventing and resolving the risk of the masses falling into poverty or returning to poverty due to illness. in the next step, we will continue to increase the guidance of the product together with relevant departments, continuously optimize the security capacity and service level, truly give full play to the supplementary security role of "wei ni bao", and effectively reduce the medical burden of the masses.
★after the coverage period of the “weinibao 2024” version is adjusted, how do renewing customers connect with their benefits?
in previous years, the insurance period of "weinibao" was from july 5 to september 25 each year, and the protection period was from september 26 to september 25 of the following year. in order to better connect the basic medical insurance benefits, the insurance period of "weinibao 2024" version was adjusted to september 2 to december 31, 2024, and the protection period was adjusted to january 1 to december 31, 2025, which is basically the same as the basic medical insurance for residents. in order to ensure that the benefits of customers who renew their insurance in 2023 are not interrupted, the "weinibao 2023+" product is specially launched for customers who renew their insurance in 2023. the insurance period of "weinibao 2023+" is from september 2 to september 25, 2024, and the protection period is from september 26 to december 31, a total of 97 days. the premium standard and deductible are reduced by a certain proportion. the premium standard is 9 yuan/person for those aged 22 years and below (inclusive), 19 yuan/person for those aged 22 years and above but below 60 years, and 39 yuan/person for those aged 60 years and above (inclusive). the compensation liability shall be implemented in accordance with the product plan of "weinibao" 2024 version. the deductible shall be reduced by 20% in principle. the deductible for expenses within the scope of the hospitalization medical insurance policy shall be 4,800 yuan, the deductible for expenses outside the scope of the hospitalization medical insurance policy shall be 13,000 yuan, and the free amount for outpatient expenses shall be 8,000 yuan. the maximum compensation amount remains unchanged. customers who have insured the "weinibao 2023" version can either purchase the "weinibao 2024" version separately according to their own needs, or choose to purchase the "weinibao 2023+" simultaneously with the "weinibao 2024" version.
★in order to effectively promote the sustainable and healthy development of "weinibao", in which aspects will supervision be strengthened in the next step?
"weinibao" customized commercial medical insurance is an important part of building a multi-level medical security system, and plays a positive role in reducing the medical burden of the masses and improving people's livelihood. in the next step, weihai financial supervision branch will continue to play a leading role in supervision, actively support and regulate the development of "weinibao" customized commercial medical insurance. on the one hand, it will strictly regulate the business behavior of underwriting institutions, strengthen communication and coordination with the municipal medical insurance bureau and other government departments, strengthen business dynamic tracking and supervision, and guide all "weinibao" undertaking institutions to adhere to the people-centered development concept, implement the main responsibility, conduct business in accordance with the law, continuously optimize claims services, and improve industry service efficiency. at the same time, it will increase the intensity of investigation and punishment of illegal and irregular behaviors, effectively maintain market order, and protect the legitimate rights and interests of consumers. on the other hand, it will actively strengthen the publicity and guidance of insurance policies, supervise all "weinibao" undertaking institutions to make full use of various media, do a good job in positive publicity and guidance, open up consultation and complaint channels, respond to social concerns in a timely manner, solve problems, resolve conflicts, and jointly promote the sustainable and healthy development of "weinibao" customized commercial medical insurance.
★what has the civil affairs department done in this "weinibao" commercial medical insurance work?
rural people in extreme poverty, people on minimum living security, and people on the edge of minimum living security are vulnerable groups in society. their basic lives are guaranteed by the government, but once they suffer from a serious illness, they are very likely to fall into poverty. as a social affairs management and service department, the municipal civil affairs bureau actively participates in the "weinibao" commercial medical insurance work. this year, it plans to allocate 1.0284 million yuan from the rural revitalization funds budgeted by the municipal charity federation. according to the standard of 39 yuan per person per year, more than 26,300 rural people in extreme poverty, people on minimum living security, and people on the edge of minimum living security will purchase "weinibao" commercial medical insurance to improve the risk resistance of people in need in our city. if the hospitalization of the needy people incurs a large amount of medical expenses, and their lives are still difficult after medical insurance, serious illness insurance, "weinibao" insurance and other policy assistance, they can apply to the civil affairs charity department for annual charitable serious illness assistance. through a combination of measures, the living burden of the needy people can be reduced to the greatest extent, and help the construction of the rural revitalization and common prosperity pilot zone in weihai city.
★can the customized commercial medical insurance "weinibao" purchased by an enterprise for its employees be deducted before tax? how to increase the awareness of the policy?
according to the enterprise income tax law and other relevant regulations, from january 1, 2008, enterprises shall, in accordance with relevant national policies, deduct the supplementary pension insurance and medical insurance premiums paid by enterprises for all employees who hold office or are employed in the enterprise, up to 5% of the total salary of the employees, when calculating the taxable income; the excess shall not be deducted. therefore, enterprises that meet the conditions can deduct the customized commercial medical insurance "weinibao" purchased for their employees before tax within a certain limit.
the weihai taxation bureau will focus on publicity and guidance to ensure that everyone knows everything about tax policies. make full use of wechat official accounts to publish relevant policies such as supplementary medical insurance premiums and supplementary pension insurance premiums. through the establishment of a "remote inquiry and handling wechat exchange group", the led scrolling publicity screen in the tax service hall, and posting and distributing publicity brochures, multi-dimensional and multi-channel policy publicity will be carried out to improve policy awareness and coverage. empower with data to ensure that tax policies are fully enjoyed. according to the applicable scope of the supplementary medical insurance premium policy, "accurate portraits" of enterprise characteristics and policy key points are made to ensure that "policies find people" more accurately. "one-on-one" guidance is carried out for qualified enterprises, and tax solutions are customized to ensure that policies are accurately implemented.
(reported by zheng li, reporter of dazhong news and dazhong daily client, and jiang lingchun, correspondent)
