The latest reimbursement policy for employee medical insurance outpatient service in 2023.

The new provisions on employee medical insurance reimbursement in 2023 are as follows:

1. Outpatient reimbursement: the deductible line for on-the-job employees is 2,000 yuan, and the reimbursement ratio is 50%; For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%; For retirees over 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 80%.

2. Hospitalization reimbursement: above the deductible and below the maximum payment limit, 85% of the class A and general medical expenses of on-the-job employees are paid; Retirees pay 90%; Class B drugs pay 75%; High technology pays 70%.

Employee medical insurance outpatient reimbursement process:

1. For outpatient and inpatient treatment, the insured person must show his social security card and swipe his card for medical treatment. The outpatient department must inform the hospital of the treatment category (such as chronic disease and outpatient service). If the card card is not produced or the treatment category is not clear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance fund;

2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the treatment category (such as outpatient chronic diseases, special), according to the relevant policies to buy drugs, because of special circumstances by others purchasing drugs, must show the insured and the purchaser's identity card, and registered by the pharmacy;

3, outpatient co-ordinate the implementation of the first diagnosis and referral system based on community health service institutions. Insured persons can be first diagnosed or referred to community-managed medical institutions in designated community health service institutions for urban workers' basic medical insurance; Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs a referral, the first-visit medical institution shall be responsible for the referral, and emergency rescue is not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, you can directly enjoy the outpatient co-ordination treatment from the next cost, without referring to the original chronic disease. After the subsidy limit for specific outpatient items is used up, referral procedures must be handled according to the provisions of outpatient co-ordination, and ordinary medical records can be used to enjoy outpatient co-ordination treatment. Buying medicine in a pharmacy does not enjoy the overall treatment of outpatient service.

To sum up, the advantage of employee medical insurance is that the protection provided by enterprise employee medical insurance includes normal outpatient and hospitalization expenses. Serious illness assistance needs to be covered by ordinary medical insurance.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.