New Rules for Outpatient Reimbursement of Medical Insurance in Guangzhou in 2023

Guangzhou medical insurance outpatient reimbursement in 2023, the latest provisions include reimbursement ratio, deductible line and capping line.

1, reimbursement ratio

The reimbursement ratio of different medical institutions is different. For on-the-job personnel, the reimbursement rate of the first-level designated institutions is 60%, that of the second-level designated institutions is 55%, and that of the third-level designated institutions is 50%; There is no provision for the reimbursement ratio of retirees, and it should be appropriately increased on the basis of the previous reimbursement ratio.

2. Deductible line and capping line

Guangdong's laws and regulations are the same for employees and retirees. The deductible line is 0, and the capping line is not less than 2% of the average annual salary of urban employees in the previous year.

Introduction of Shenzhen reimbursement regulations:

1, Class A drugs: designated institutions at the first level, with 75% reimbursement for employees and 80% reimbursement for retirees; Secondary designated institutions, the reimbursement rate of employees is 65%, and the reimbursement rate of retirees is 70%; At the third-level designated institutions, the reimbursement rate for employees is 55%, and the reimbursement rate for retirees is 60%.

2. Class B drugs: the first-class designated institutions, the reimbursement rate of employees is 70%, and that of retirees is 75%; Two designated institutions, 60% of employees and 65% of retirees are reimbursed; In the third-level designated institutions, the reimbursement rate for on-the-job personnel is 50%, and that for retirees is 55%.

3. There are requirements for the capping line, which cannot exceed 5% of the average annual salary of employees in Shenzhen last year; The annual maximum payment limit of general outpatient medical expenses in hospitals and specialized hospitals above the second level shall not exceed 2.5% of the average annual salary of employees in this city in the previous year.