2021-2022 Changzhou medical insurance reimbursement ratio, policy, conditions, scope

I. Outpatient Medical Reimbursement and Ratio

1. General Outpatient Coordination

The medical insurance fund subsidizes a certain percentage of the outpatient medical expenses of the insured that exceed the starting standard but are within the maximum limit in accordance with the regulations within a natural year. The specific standards are shown in the following table:

2. Outpatient large medical expenses subsidy

In an insurance year, among the general outpatient medical expenses within the scope of medical insurance incurred by the participants of the Employees' Basic Medical Insurance at the designated medical institutions (except for the ones included in the scope of the coverage of the insurance for the major illnesses), the portion of the individual out-of-pocket expenses exceeding

6,000 yuan after payment by the Employees' Basic Medical Insurance Fund in accordance with the regulations is paid by the Employees' Medical Aid Fund at a rate of 50% of the outpatient medical expenses. The medical aid fund shall provide subsidies at a rate of 50%, with a maximum subsidy limit of 100,000 yuan.

The conditions and scope of medical expenses for the employee outpatient large medical expense subsidy are the same as those for the employee basic medical insurance general outpatient coordination.

3, outpatient chronic disease medication subsidies

Participants in the designated units in line with the provisions of the provisions of the outpatient chronic disease medication subsidies catalog range of drugs, in line with the provisions of the medical insurance can enjoy subsidies.

The outpatient chronic disease medication subsidy amount is used on a monthly basis, the balance of the month can be transferred to the next month, the cumulative amount is valid for the year, and recalculated for the following year.

4. Outpatient Specific Diagnostic and Treatment Program Subsidies

You can enjoy outpatient specific diagnostic and treatment program treatment directly by swiping your card at the designated medical institutions without going through other procedures.

5. Outpatient Specific Disease Subsidies

The outpatient treatment of the following diseases, in accordance with the provisions of the medical expenses can be entitled to subsidies. Among them, severe mental illness and hepatitis C are only eligible for subsidies for the outpatient use of a specified range of drugs.

6. Outpatient Major Disease Subsidies

In a year, when the following major diseases are treated on an outpatient basis at a selected designated medical institution, the outpatient medical expenses in accordance with the regulations can be eligible for subsidies.

The scope and proportion of reimbursement for hospitalization

Within a billing year, the medical expenses incurred by the insured person for hospitalization in compliance with the regulations, exceeding the starting standard, will be paid by the medical insurance co-ordination (assistance) fund on a pro rata basis. The city is required to hold a social security card to swipe the card for medical treatment.

Emotional mental disorders (mania, manic-depressive disorder), hospitalized participants in the medical costs, in the original individual out-of-pocket proportion of the paragraph were reduced by half.