Detailed Rules for Outpatient Reimbursement of Dalian Medical Insurance 2024

1. Reimbursement scope: outpatient registration fee, medical treatment fee, examination fee, medicine fee and other expenses can be reimbursed.

2. Reimbursement ratio: the reimbursement ratio of outpatient expenses varies according to the type of medical insurance and different regions. Generally speaking, the reimbursement rate of urban workers and urban and rural residents' medical insurance clinics is high, while the reimbursement rate of commercial insurance and civil servants' medical insurance clinics is low.

Dalian medical insurance outpatient reimbursement rules in 2024 are as follows:

Special tertiary medical institutions? (Including the First Affiliated Hospital of Dalian Medical University? The Second Affiliated Hospital of Dalian Medical University. Dalian Central Hospital? Zhongshan Hospital affiliated to Dalian University. The Qifubiaozhun for reimbursement of medical insurance outpatient service for employees is 600 yuan, and the reimbursement rate is 50% for on-the-job employees and 55% for retired employees.

The qifubiaozhun for reimbursement of medical insurance outpatient service for employees in tertiary medical institutions is 400 yuan, and the reimbursement rate is 55% for on-the-job employees and 60% for retired employees.

Tertiary specialized medical institutions? Qifubiaozhun for medical insurance outpatient reimbursement for employees is 400 yuan, and the reimbursement ratio is 60% for employees and 65% for retired employees.

The qifubiaozhun for reimbursement of medical insurance outpatient service for employees in secondary (including secondary and below specialties) medical institutions is 200 yuan, and the reimbursement ratio is 65% for on-the-job employees and 70% for retired employees.

First-class and below medical institutions? (including first-class hospitals? , community health service center? (station), township hospitals? Wait a minute. 200 yuan, the threshold fee for reimbursement of medical insurance outpatient service for employees, accounts for 70% of on-the-job employees and 75% of retired employees. The reimbursement rate will increase by 10 percentage point if you sign a contract with a family doctor to upgrade the service package and see a doctor in a contracted primary medical institution.

The annual payment ceiling of general outpatient service of medical insurance for employees in Dalian remains unchanged, which is 6.5438+0.2 million yuan.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

To sum up, it is Bian Xiao's relevant answer to Dalian Medical Insurance Outpatient Reimbursement Rules 2024, and I hope it will help you.

legal ground

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.