What is the reimbursement amount for employee medical insurance outpatient service?

Theoretically, the insured person of outpatient medical insurance can be reimbursed up to 6.5438+0.7 million yuan, of which enterprises and individuals each bear 72,000 yuan. 1. general outpatient service: in a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund are reimbursed at the rate of 60%. The maximum annual payment limit for individuals of the overall fund is 400 yuan.

2. Special diseases: In a medical insurance year, the deductible for outpatient service of special diseases is 400 yuan, and the proportion of reimbursement for medical expenses meeting the prescribed treatment scope is the same as that for general hospitalization.

1. On-the-job employees: the deductible for outpatient service is 2000 yuan, that is, the medical expenses incurred in outpatient service that exceed 2000 yuan will be reimbursed, and the reimbursement ratio is 50%;

2. Retired employees: The outpatient service fee is 1.300 yuan, that is, only the part that exceeds 1.300 yuan is reimbursed, with 70% for those under 70 years old and 80% for those over 70 years old.

3. Maximum amount: No matter what kind of people, the maximum amount of outpatient and emergency medical expenses is 20,000 yuan.

How to use medical insurance to reimburse outpatient service? 1, prepare outpatient reimbursement materials:

(1) Original ID card and social security card;

(2) The original disease diagnosis certificate issued by the tertiary or secondary hospitals of designated medical institutions;

(3) original medical data such as outpatient service, examination and test results report;

(4) The original receipt of outpatient charges of medical institutions with unified finance and taxation;

(5) The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

(6) Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

(7) If acting as an agent, provide the original ID card of the agent.

2. The social security center handles the reimbursement procedures. After preparing the above materials, you can apply to the relevant departments of the local social security center. Upon examination, if the materials are complete and meet the requirements, you can apply immediately;

3. When the applicant applies for reimbursement of outpatient medical expenses, the medical insurance premium included in the personal account in this social security year shall be deducted first, and then the reimbursement amount shall be verified.

Outpatient medical insurance insured can be reimbursed up to 6.5438+0.7 million yuan for medical treatment, of which enterprises and individuals each bear 72,000 yuan.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.