Dalian medical insurance outpatient reimbursement rules 2024

1. Scope of reimbursement: Outpatient registration fee, consultation fee, examination fee and medicine fee can be reimbursed.

2. Reimbursement rate: The reimbursement rate for outpatient expenses varies depending on the type of medical insurance and the region in which you live. Overall, urban workers' and urban and rural residents' health insurance have high compensation for patients' outpatient reimbursement, while commercial insurance and civil servants' health insurance have low reimbursement rates for outpatient services.

Dalian health insurance outpatient reimbursement rules 2024 are as follows:

Special tertiary medical institutions? (including the First Hospital of Dalian Medical University? , the Second Hospital of Dalian Medical University? Dalian Center Hospital, Zhongshan Hospital of Dalian University, and Dalian University Hospital of Dalian. (including Zhongshan Hospital of Dalian University?) The threshold fee for outpatient reimbursement under the Employee Medical Insurance is 600 yuan, and the reimbursement rate is 50% for active employees and 55% for retired employees.

The threshold fee for outpatient reimbursement of employee health insurance for Level III medical institutions is RMB 400, and the reimbursement rate is 55% for active employees and 60% for retired employees.

Tertiary specialized medical institutions? The threshold fee for outpatient reimbursement under the employee health insurance is 400 yuan, and the reimbursement rate is 60% for active employees and 65% for retired employees.

The threshold fee for outpatient reimbursement of employee health insurance for second-level (including second-level and lower specialties) medical institutions is 200 yuan, and the reimbursement rate is 65% for active employees and 70% for retired employees.

The first level and the following medical institutions? (including first-class hospitals? , community health service centers? (stations), township health centers? (etc.) The threshold fee for outpatient reimbursement of employee health insurance is 200 yuan, and the reimbursement rate is 70% for active employees and 75% for retired employees. The reimbursement rate will be increased by another 10 percentage points for those who sign up for an upgraded service package with a family doctor and visit a contracted primary care facility.

The annual payment ceiling for general outpatient coordination under Dalian's employee health insurance remains unchanged at 12,000 yuan.

Medical insurance reimbursement process:

1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their treatment items belong to the scope of reimbursement of medical insurance;

2, collection of reimbursement materials: collection of the relevant records of treatment, drug receipts, list of medical expenses and other related materials;

3, to the social security department for reimbursement: submit the relevant materials to the local social security department to handle the reimbursement.

4, wait for the audit: the social security department will carry out the relevant audit and comparison, to confirm the reimbursement rate and reimbursement amount; receive reimbursement: after the audit, you can collect the reimbursement amount of medical insurance in the designated bank

The above is the editorial on the outpatient reimbursement rules of the Dalian medical insurance 2024 made relevant answers, hope can help you I hope it can help you.

Legal basis

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.