Jinan outpatient overall reimbursement policy 2022

After the insured’s inpatient, outpatient chronic disease and general outpatient coordinated medical expenses incurred within a medical year are reimbursed by the employee basic medical insurance unified fund and large medical expense relief fund, the total accumulated personal burden will be The portion of the regulated medical expenses exceeding RMB 10,000 can also be reimbursed twice by the Large Medical Expenses Relief Fund. There is no need to go through any formalities for secondary reimbursement, and it can be automatically reimbursed during settlement. ‘

Medical insurance is one of my country’s basic social security policies, providing basic protection for the health of our residents.

Outpatient service: Village clinics and village central clinics are reimbursed 60% of the time, with a limit of RMB 10 for prescription drugs per visit, and a limit of RMB 50 for temporary rehydration prescriptions by doctors at health centers. Town health centers are reimbursed for 40% of the time, with a limit of RMB 10 for each visit. The limit of examination fees and operation fees per visit is 50 yuan, and the limit of prescription drugs is 100 yuan. The reimbursement for visits to secondary hospitals is 30%. The limit for examination fees and operation fees for each visit is 50 yuan. The limit for prescription drugs is 200 yuan. The reimbursement for visits to tertiary hospitals is 30%. 20%, the examination fee and operation fee limit for each visit is 50 yuan, the prescription drug fee limit is 200 yuan, the traditional Chinese medicine invoice is attached with a prescription subsidy limit of 1 yuan, and the annual cooperative medical outpatient compensation limit is 5,000 yuan.

Hospitalization: Reimbursement scope:

Medicine expenses: Auxiliary examinations: ECG, X-ray, film, laboratory tests, physical therapy, acupuncture, CT, MRI, etc. The limit for each examination fee is 200 yuan for surgery (refer to the national standard, and if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan). If an elderly person over 60 years old is hospitalized in a health center, the treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.

Reimbursement ratio: The town health center reimburses 60%, the first-level hospital reimburses 40%, and the first-level hospital reimburses 30%.

Severe illness: Any inpatient who participates in the cooperative medical care will be compensated in stages if the one-time or annual cumulative medical expenses exceed 5,000 yuan, that is, 65% will be compensated for 5,001-10,000 yuan, and 70% will be compensated for 10,001-18,000 yuan. .

The annual compensation limit for town-level cooperative medical inpatient and uremia outpatient hemodialysis, and cancer outpatient radiotherapy and chemotherapy is 11,000 yuan.

Legal basis:

"Social Insurance Law of the People's Republic of China" Article 23 Employees shall participate in employee basic medical insurance, which shall be provided by the employer and employees in accordance with national regulations* **Same as paying basic medical insurance premiums. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other people with flexible employment can participate in the basic medical insurance for employees, and individuals must pay the basic medical insurance premiums in accordance with national regulations.