Proportion of reimbursement for outpatient medical insurance in Guangzhou

What is the reimbursement ratio of Guangzhou residents' medical insurance outpatient service?

The reimbursement rate of general outpatient medical insurance for Guangzhou residents is 50%, and the specific reimbursement rate may be different according to the hospital level and drug type.

In Guangzhou, the insured can enjoy the general outpatient treatment of residents' medical insurance in designated medical institutions and retail pharmacies in the city. According to the level of the hospital, the reimbursement rate is divided into three grades: 85% in the first-class hospital, 80% in the second-class hospital and 75% in the third-class hospital.

In addition, when the insured person goes to the designated medical institutions in the city for medical treatment, he must carry valid identity documents and medical insurance electronic certificate. When purchasing medicines in designated retail pharmacies, you need to show your medical insurance electronic certificate or valid identification.

It should be noted that the medical insurance fund pays medical expenses in accordance with the principle of "fixed income and expenditure, balance of payments". Insured persons should pay medical insurance premiums according to regulations in order to enjoy the corresponding medical security benefits.

The scope of reimbursement for medical insurance in Guangzhou includes drugs, examinations, treatment methods and accommodation fees within the standard. Specifically, the drugs, tests and treatment methods listed in the medical insurance catalogue are within the scope of medical insurance reimbursement, and the accommodation fees within the standard are the expenses that can be reimbursed when hospitalized in the specified medical institutions.

For drug reimbursement, Guangzhou Medical Insurance Bureau stipulates that only drugs in the medical insurance catalogue can enjoy medical insurance reimbursement treatment, and self-funded items cannot be paid by personal account of medical insurance card. When purchasing medicine, you need to consult a doctor or pharmacy staff to determine whether it is within the scope of medical insurance reimbursement.

In addition, Guangzhou Medical Insurance Bureau also stipulated the scope of reimbursement for some special circumstances. For example, medical insurance can reimburse some outpatient treatment expenses of patients with special diseases; For the self-funded part of inpatients, medical insurance can also bear part of it. The specific reimbursement ratio and limit can be found in official website of Guangzhou Medical Insurance Bureau or related medical institutions.

In short, the scope of medical insurance reimbursement in Guangzhou is relatively wide, but the specific reimbursement ratio and limit need to be determined according to different diseases and medical institutions. When enjoying medical insurance benefits, you need to abide by relevant regulations and procedures to ensure that your rights and interests are protected.

To sum up, the reimbursement rate of general outpatient medical insurance for Guangzhou residents is 50%, and the specific reimbursement rate will be different according to the hospital level and drug type. Insured persons need to carry valid identity documents and medical insurance electronic certificate when seeking medical treatment, and pay medical insurance premiums according to regulations.

Legal basis:

Article 34 of the Measures for Social Medical Insurance in Guangzhou stipulates: "Insured persons can purchase medicines at designated medical institutions and retail pharmacies in this city according to regulations and enjoy social medical insurance benefits. Show medical insurance electronic certificate or valid identification when seeking medical treatment at designated medical institutions in the city, and show medical insurance electronic certificate or valid identification when purchasing medicines at designated retail pharmacies. "

Article 35 of the Measures for Social Medical Insurance in Guangzhou stipulates: "The medical expenses paid by the insured for hospitalization, designated single diseases, specific outpatient items, emergency treatment, trauma, chronic disease outpatient service and overall planning fund shall be paid by the social medical insurance fund in accordance with the following provisions: (1) The hospitalization medical expenses shall be paid by the basic medical insurance fund in proportion."