What is the policy of Hainan medical insurance outpatient service? Detailed provisions are as follows

With the establishment of the medical insurance outpatient co-ordination guarantee mechanism, in order to improve the reimbursement ratio of medical insurance outpatient service, the amount of individual medical insurance account has also been reduced, and the reduced money directly enters the medical insurance co-ordination fund account. At present, the reimbursement rate of medical insurance clinics across the country has reached more than 50%. So what is the policy of Hainan medical insurance outpatient service? Let's get to know each other.

What is Hainan's medical insurance outpatient policy?

1 reimbursement ratio: the reimbursement ratio of Hainan medical insurance outpatient service is determined by designated institutions, and the reimbursement ratio of first-class and below medical institutions is 70%; The reimbursement rate of secondary medical institutions is 60%; The reimbursement rate of tertiary medical institutions is 50%.

2 deductible line and capping line: the deductible line for medical insurance reimbursement of employees and retirees is also determined by medical institutions, and the deductible line for medical institutions of level I and below is 10 yuan; 50 yuan, the deductible line of secondary medical institutions; Deductible line of tertiary medical institution 100 yuan. The ceiling line for employees 1500 yuan, and the ceiling line for retirees is 2000 yuan.

The regulation of the ceiling line means that employees can be reimbursed up to 1500 yuan, and retirees can be reimbursed up to 2,000 yuan. Assuming that the retirees in Hainan Province spend 2500 yuan on medical treatment in tertiary hospitals, and the amount that can be reimbursed at the time of discharge settlement is (2500-100) * 50% =1200 yuan, then the actual expenses to be paid are 2500- 1200 yuan.