Guangzhou social security card attached to the hospital.

Guangzhou social security card attached to the hospital.

Answer: The insured should choose 1 primary medical institution (referred to as "Little Point") as the designated hospital institution for general outpatient service in this city. After the "small point" is selected, 1 other medical institutions (referred to as "big point") can be selected as the selected hospital institution for general outpatient treatment in this city.

Reference policy: Notice of Guangzhou Medical Insurance Bureau, Guangzhou Finance Bureau and Guangzhou Health and Wellness Committee on the scope and standard of Guangzhou employee social medical insurance pooling fund to pay general outpatient medical expenses.

All relevant units and social insurance designated medical institutions:

In order to further improve the social medical insurance policy and reduce the burden of medical expenses of the insured, according to the relevant provisions of the Regulations of Guangzhou Municipality on Social Medical Insurance and the Measures of Guangzhou Municipality on Social Medical Insurance (Order No.23), Guangzhou Municipal People's Government 123), the relevant matters concerning the scope and standard of medical expenses paid by the social medical insurance pooling fund for general outpatient service and emergency service (hereinafter referred to as general outpatient service) are hereby notified as follows:

First, the social medical insurance for employees (hereinafter referred to as the insured) shall go through the selection procedures in accordance with the following provisions, enjoy the overall treatment of the general outpatient service in this Municipality, and go to the designated medical institutions for outpatient treatment:

(1) The insured chooses 1 as his general outpatient medical institution in the list of primary medical institutions designated by the municipal medical insurance agency (hereinafter referred to as the selected primary medical institution).

After the insured chooses the primary medical institutions, they can choose 1 other medical institutions as their general outpatient medical institutions (hereinafter referred to as the selected other medical institutions) in the designated medical institutions in this Municipality.

Insured persons in the specialized medical institutions designated by the municipal medical insurance agencies to carry out the corresponding specialized outpatient medical treatment is not restricted by the selection point, and the list of designated institutions shall be announced separately by the municipal medical insurance agencies.

(2) Once the selected primary medical institutions and other medical institutions are confirmed, in principle, they shall not be changed within a natural year (that is, from February 1 to 1 of that year). However, if the insured person changes his/her household registration, residence, work unit and qualification of designated medical institutions during the year, he/she can go through the formalities of change in the medical insurance agency.

(three) the general outpatient expenses incurred by the insured to non-designated medical institutions or non-designated specialized medical institutions shall not be paid by the overall fund.

Two, the insured in accordance with the provisions of the general outpatient basic medical expenses, the overall fund to pay according to the following provisions:

(a) in the selected primary medical institutions for medical treatment, the overall fund payment ratio is 80%; The payment ratio is 55% for those who seek medical treatment in other selected medical institutions and designated specialized medical institutions within 30 days after being referred by the selected primary medical institutions; Without the selected primary medical institutions for referral, to other selected medical institutions and designated specialized medical institutions for medical treatment, the payment ratio is 45%; The expenses incurred in the use of essential drugs shall be implemented in accordance with the relevant provisions of social medical insurance in this Municipality.

(two) the maximum monthly payment limit of the overall fund is 300 yuan, and the maximum monthly payment limit is valid in the current month, neither cumulative nor cumulative.

(three) the insured does not enjoy the overall treatment of general outpatient service during hospitalization; Insured persons enjoy social medical insurance benefits for outpatient specific diseases, and will not repeat the overall treatment of general outpatient service.

Third, the insured persons who have been treated in different places for a long time will be paid the overall treatment of general outpatient service by the overall fund based on the monthly payment base of their employees' social medical insurance, in which the average monthly salary of employees in this city in the above years is the base, according to the original standard of 2% per person per month for medical treatment in this city and Item (2) of Article 2 of this notice.

Four, the overall fund to pay the basic medical expenses for general outpatient service shall comply with the relevant provisions of the national and provincial drug list and the scope of use of social medical insurance in this Municipality. See relevant documents for the specific general outpatient drug list and diagnosis and treatment project list.

Five, the insured in accordance with the provisions of the general outpatient basic medical expenses, which belong to the individual payment part, directly settled by the insured and the designated medical institutions; Belong to the part of the overall fund payment, by the designated medical institutions first accounting, monthly summary to the medical insurance agencies to declare settlement. The specific settlement measures shall be agreed by the municipal medical insurance agency in signing a service agreement with designated medical institutions according to the prescribed standards and methods.

Six, the municipal medical insurance agencies in accordance with the provisions of this notice to develop specific operating guidelines.

VII. This notice shall come into force on June 1 day+10/October 65438, 2020, and shall be valid for 5 years. As of the date of implementation of this notice, the Notice of Guangzhou Municipal Bureau of Human Resources and Social Security, Guangzhou Municipal Finance Bureau and Guangzhou Municipal Health Bureau on the Scope and Standard of Guangzhou Workers' Social Medical Insurance Co-ordination Fund to Pay General Outpatient Medical Expenses (Sui Ren She Fa [2014] No.51) shall be abolished at the same time.