Proportion of social security outpatient reimbursement in 2023

In 2023, the reimbursement ratio of social security clinics is as follows:

1. On-the-job employees: the deductible for outpatient service is 2,000 yuan, that is, the part with a width exceeding 2,000 yuan will be reimbursed, and the reimbursement ratio is 50%;

2. Retired employees: The deductible of outpatient service is 1.300 yuan, that is, the part of medical expenses incurred in outpatient service that exceeds 1.300 yuan is reimbursed by the state. Under 70 years of age, the reimbursement rate is 70%, and over 70 years of age, the reimbursement rate is 80%;

3. Maximum amount: No matter what kind of people, the maximum amount of outpatient and emergency medical expenses is 20,000 yuan;

4. Special diseases: In a medical insurance year, the deductible for outpatient service of special diseases is 400 yuan, and the proportion of reimbursement for medical expenses meeting the prescribed treatment scope is the same as that for general hospitalization.

Social security reimbursement generally needs to go through the following steps:

1. See a doctor: when seeing a doctor, you should choose medical institutions that meet your own social security type, such as community health service centers and general hospitals, and you should be hospitalized or out-patient according to regulations;

2. Payment: you need to pay the corresponding medical insurance expenses before going to the doctor, which are generally part of your own expenses and part of your personal account. The payment standard varies according to the local medical insurance policy;

3. Reimbursement: After seeing a doctor, you need to submit relevant medical expense documents, prescriptions, medical insurance cards and other materials to the local social security department for reimbursement. Pay attention to fill in the correct information, such as medical records and expense lists. When reimbursing, let the social security department review the reimbursement;

4. Get reimbursement: After the reimbursement is approved, the social security department will transfer the reimbursement to the personal account or directly refund the money to the personal account, depending on the local medical insurance policy.

To sum up, social security policies in different regions may be different, and the specific reimbursement standards and procedures need to be operated according to local policies and regulations. At the same time, when seeking medical treatment and reimbursement, we also need to pay attention to abide by medical norms and social security regulations to avoid unnecessary troubles and expenses.

Legal basis:

Article 8 of the Special Provisions on Labor Protection of Female Workers

Maternity allowance for female employees during maternity leave shall be paid by the maternity insurance fund according to the standard of the average monthly salary of employees in the previous year; Those who have not participated in maternity insurance shall be paid by the employer according to the wage standard of female employees before maternity leave. Medical expenses incurred by female workers in childbirth or abortion shall be paid by maternity insurance fund according to the items and standards stipulated in maternity insurance. Did not participate in maternity insurance, paid by the employer.

Article 53 of the Social Insurance Law of People's Republic of China (PRC)

Employees shall participate in maternity insurance, and the employer shall pay maternity insurance premiums in accordance with state regulations, and employees shall not pay maternity insurance premiums.

Article 54

The employer has paid maternity insurance, and its employees enjoy maternity insurance benefits; Unemployed spouses of employees enjoy maternity medical expenses in accordance with state regulations. The required funds are paid from the maternity insurance fund.

Maternity insurance benefits include maternity medical expenses and maternity allowance.