Guangzhou employee medical insurance outpatient reimbursement quota

Guangzhou medical insurance general outpatient reimbursement limit:

Employee medical insurance: 300 yuan/month;

Minors and students in residents' medical insurance: 1000 yuan/month;

Medical insurance for other urban and rural residents: 600 yuan/month.

Guangzhou medical insurance reimbursement ratio:

Grassroots community hospitals (small points): 80%;

Large general hospital (big point): 55% according to small point; 45% had no referral.

Referrals from small to large can exaggerate 10%.

The employee medical insurance insured person goes to the "small point" clinic for medical treatment, and the outpatient reimbursement rate is 80%; Go directly to the "big point" clinic, and the reimbursement rate is 45%. If you go to a "small point" clinic for medical treatment within 30 days after the first visit, the reimbursement rate is 55%, and you can overstate 10%.

The single referral of "Little Point" is valid within 30 days. During this period, patients can enjoy 55% medical insurance reimbursement no matter how many outpatient treatments are conducted in the selected "big spots", provided that the monthly limit (employee medical insurance) is within 300 yuan. If the referral period exceeds 30 days, the reimbursement rate for "big spots" will be reduced from 55% to 45%.

Common diseases that can be solved in small spots are solved near designated small spots, which avoids the time-consuming and laborious trouble of queuing for treatment in large spots. The reimbursement rate of outpatient service can be as high as 80%, which can save 25% ~ 35% compared with larger ones. This is still very cost-effective for some elderly groups. Therefore, it is more cost-effective for patients to go to the community for treatment of minor illnesses such as colds and fever.

Common diseases can be found in secondary hospitals, and the fees are lower. Due to the different classification of medical institutions, the related charges of district-level secondary hospitals, including drug pricing, are lower than those of tertiary hospitals 10%, and the charges of secondary hospitals are 90% of those of tertiary hospitals. Therefore, if it is not an incurable disease, but a common, frequently-occurring and rehabilitative disease, you can choose the "strength department" of a second-class district-level hospital for treatment.

To sum up: Guangzhou medical insurance general outpatient reimbursement limit:

Employee medical insurance: 300 yuan/month;

Minors and students in residents' medical insurance: 1000 yuan/month;

Medical insurance for other urban and rural residents: 600 yuan/month.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.