Can gastroscope outpatient service be reimbursed?

The reimbursement rate is generally around 80%.

Medical insurance reimbursement scope:

1, medical expenses insurance liability in medical insurance coverage.

Part of the expenses still borne by individuals after reimbursement of basic medical insurance, serious illness insurance and medical assistance in the medical insurance catalogue. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,10.5 million free of compensation, the reimbursement rate is 80%, and the reimbursement rate for continuous participation is increased to 85%;

2, medical insurance liability outside the scope of hospitalization expenses.

The expenses outside the medical insurance catalogue are still borne by individuals after being reimbursed by basic medical insurance, serious illness insurance and medical assistance. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,1.8,000 free of compensation, the reimbursement rate is 60%, and the reimbursement rate for continuous participation is increased to 65%;

3, outpatient specific high drug cost insurance liability

The part of the drug expenses paid by designated hospitals and pharmacies that is borne by individuals shall bear the responsibility for payment within the agreed scope of insurance liability. 700,000 insured amount, 26 kinds of drugs, and the insurance liability of the outpatient drugs/inpatient medical insurance expenses for rare diseases is * * * 20,000 yuan, and the compensation ratio is 80%;

4. Clearly stipulate the insurance liability of outpatient drugs/hospitalization medical insurance expenses for rare diseases.

The part of the drug expenses paid in designated hospitals and pharmacies, which is borne by individuals, shall be liable for compensation within the agreed scope of insurance liability. The insured amount is 300,000 yuan, 12 kinds of drugs, and the insurance liability of outpatient specific high drug expenses is 20,000 yuan, and the reimbursement ratio is 70%.

Medical insurance reimbursement method:

1. If you are hospitalized in a designated medical institution, you will bring your medical insurance card and ID card to the settlement window of the designated hospital for direct settlement and accounting when you leave the hospital;

2. If you seek medical treatment in a different place, call the social security bureau where the insured person is located within three days of admission, register for the record, and return to the local social security bureau for reimbursement within one month.

Medical insurance reimbursement conditions:

1, the newly insured and re-insured employees who have stopped paying 1 year or more shall participate in the basic medical insurance according to law and pay for 6 months continuously, and enjoy the basic medical insurance benefits according to regulations;

2, continuous payment of less than 6 months, do not enjoy the basic medical insurance benefits;

3. If the payment is interrupted for less than one year, you will enjoy the treatment according to the regulations after re-insurance payment;

4, the interruption of payment personnel do not enjoy the basic medical insurance benefits during the interruption of payment.

To sum up, basic medical insurance (including basic medical insurance for urban workers and basic medical insurance for urban and rural residents) is closely related to inclusive prices. Focus on ensuring the high medical expenses caused by major diseases and accidental injuries, and provide more adequate protection for major diseases. Compared with general commercial insurance, there are no restrictions on the age and occupation of the insured, and the health conditions are more tolerant. At the same time, the treatment cost of 20 kinds of high-priced specific drugs and 10 kinds of designated rare diseases drugs outside the medical insurance catalogue has been expanded.

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.