The outpatient reimbursement policy of medical insurance in Fuzhou in 2022

Medical insurance refers to social medical insurance, which is a social insurance system established to provide basic medical needs for workers within the scope of protection. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. Please tell us something about Fuzhou medical insurance reimbursement. It mainly includes Fuzhou medical insurance reimbursement process, Fuzhou medical insurance reimbursement ratio, Fuzhou medical insurance reimbursement policy and other information.

I. Fuzhou Medical Insurance Reimbursement Process and Requirements for Materials Required for Reimbursement

Reimbursement conditions:

The applicant went through the insurance procedures, paid the medical insurance premium in full, and went to the designated medical institution of cooperative medical care for medical treatment, and the drugs used were within the scope of reimbursement.

One: If you have a social security card, you can apply for reimbursement directly when you seek medical treatment.

Two: The medical insurance card needs to be reimbursed manually as follows.

1. Medical expenses of designated medical institutions that cannot swipe their cards due to computer failure (indicated by the hospital and stamped with the official seal);

2. Medical expenses during the annual downtime of medical insurance information system data (per year 1 month 1-3 days);

3. Approved medical expenses for out-of-hospital hospitalization;

4. Medical expenses that need to be re-settled for critical illness rescue;

5. Medical expenses that can be settled according to regulations after the social security card is frozen;

6. Medical expenses incurred during the period of not receiving the social security card;

7. Medical expenses incurred by resettlement personnel in designated hospitals;

8. Medical expenses incurred due to travel or visiting relatives and friends who suffer from acute diseases in different places and need to be hospitalized locally.

Reimbursement materials

Reimbursement materials for residents or employees:

1. Original and photocopy of my social security card or ID card (newborn household register);

2. Outpatient medical records and photocopies of designated medical institutions, general list of medical expenses, effective charging documents, short-term doctor's orders of residents and discharge summary. (The above materials need to be stamped with the official seal of the hospital);

3, the insured shall provide the "Fuzhou basic medical insurance insured inpatient medical identity checklist";

4. My settlement account of China Agricultural Bank.

5. Compensation under special circumstances

Materials provided by college students for manual reimbursement

1. Rong application form for reimbursement of medical expenses for college students (school seal)

2, the original medical bills (official seal of the hospital);

3. General list of medical expenses (official seal of the hospital). During school (except holidays and internships)

For medical treatment in different places, you need to submit the Examination and Approval Form for College Students' Hospitalization in Different Places in Rong.

The medical expenses of general outpatient service and infectious diseases in different places are not included in the scope of medical insurance reimbursement;

If you are hospitalized due to trauma, you also need to submit the Application Form for the Insured to Brush the Medical Insurance Card for Trauma Hospitalization.

(The above forms can be downloaded from the website of the Medical Insurance Center or collected by the school, which needs to be stamped and confirmed by the school).

The insured college students will put the reimbursement materials into the acceptance box set up by the municipal medical insurance center in colleges and universities, and the municipal medical insurance center will entrust the postal service to collect them at colleges and universities regularly, and the medical insurance center will settle the accounts within the prescribed time limit.

Reimbursement process

Reimbursement process:

1, social security cards can be paid directly in hospitals and clinics.

2. If you don't use the medical insurance card, you can prepare all the materials and submit them to Fuzhou Medical Insurance Management Center for reimbursement within the specified time.

Two, Fuzhou medical insurance reimbursement ratio and related policy reimbursement ratio and scope.

The medical expenses paid by the basic medical insurance fund must meet the requirements.

1, basic medical insurance coverage

2, the basic medical insurance diagnosis and treatment project scope

3, the basic medical insurance medical service facilities standard range

4, outpatient special diseases and diagnosis and treatment project directory scope has corresponding management regulations.

Proportion of reimbursement for urban residents and college students:

First, the general outpatient compensation treatment

Reimbursement ratio: 50%

Annual maximum payment limit (400 yuan/person calculated according to actual reimbursement amount)

Note: The maximum annual payment limit for college students (including minimum payment standard and proportional out-of-pocket expenses): 2,000 yuan/person.

Second, the special disease outpatient compensation treatment

The reimbursement rate for outpatient service for special diseases is 60%.

Outpatient expenses for serious diseases and special diseases (within 60,000 yuan (including 60,000 yuan): 70%; More than 60,000 yuan to 6.5438+0.4 million yuan (including 40% of the reimbursement ratio of 6.5438+0.4 million yuan)

Third, hospitalization compensation treatment

The expenses in basic medical insurance coverage are ≤ 60,000 yuan (the reimbursement ratio is 55%-90%).

60 thousand yuan

According to the above qifubiaozhun, the number of hospitalizations will decrease 100 yuan in turn until it drops to zero.

Employee reimbursement ratio:

First, the general outpatient compensation treatment

Pay line 1500 yuan and below: pay by personal account, and pay in cash when personal account is insufficient.

1above 500 yuan-below 6000 yuan (inclusive)

Active employees: 60%-65%, retired employees: 70%-75%.

Two, employee medical insurance outpatient special diseases

1, deductible line and capping line

The deductible line of outpatient special diseases and treatment items: 800 yuan, and the highest payment limit of the overall fund in that year: 6,543,800 yuan+0.2 million yuan.

On-the-job personnel special diseases and treatment project expenses: 85%-90%.

Retirees' expenses for special diseases and treatment items: 90%-94%.

Three, the hospitalization fund

Qifubiaozhun for the first hospitalization: the first hospitalization deductible line of tertiary designated medical institutions is 800 yuan, and the first hospitalization deductible line of secondary and below designated medical institutions is 600 yuan (including community health service centers and township hospitals 300 yuan).

Hospitalization for many times during the year: 200 yuan decreased gradually every time until it decreased to zero.

2, overall fund payment ratio

On-the-job employee hospitalization medical expenses: 80%-92%

Hospitalization medical expenses of retirees: 90%-95%.

Four. Supplementary insurance for large medical expenses of employees

65438+200,000 yuan