How to reimburse residents' medical insurance outpatient service

The outpatient reimbursement of residents' medical insurance has the following steps:

1. See a doctor: When residents go to the clinic, they need to give their medical insurance cards to the hospital, and the hospital will swipe their cards and issue an invoice for the clinic.

2. Payment: Residents need to pay a certain proportion of medical expenses on outpatient invoices, and the rest will be paid by the medical insurance pooling fund.

3. Reimbursement: Residents need to submit the outpatient invoice and medical insurance card to the social security card service station or medical insurance agency for reimbursement within the specified time.

4. Audit: The social security card service station or the medical insurance agency will audit the outpatient invoices to ensure the authenticity and rationality of the expenses.

5. Examination and approval: The medical insurance agency approves the reimbursement after examination, and credits the reimbursement amount into the resident bank card.

The specific steps of reimbursement for residents' medical insurance outpatient service include confirming medical insurance identity, registering for medical treatment, providing expense invoices, reimbursement for hospitalization and refund of fees. Residents should operate according to the requirements of the hospital and keep relevant invoices and reimbursement vouchers. There may be differences in medical insurance policies and reimbursement rates in different regions, so residents should understand the local medical insurance policies.

The scope of reimbursement for residents' medical insurance outpatient service includes the following categories:

1. Drug expenses: including western medicine, Chinese patent medicine, Chinese herbal pieces, etc.

2. Medical expenses: including doctors' medical expenses, examination expenses and treatment expenses.

3. Material cost: including operation material cost and testing material cost.

4. Other expenses: including registration fee and infusion fee.

To sum up, the reimbursement rate of residents' medical insurance clinics varies from region to region, generally between 50% and 90%. Among them, 50% is the lowest reimbursement rate and 90% is the highest reimbursement rate. Generally speaking, the higher the reimbursement rate, the smaller the economic burden of residents.

Legal basis:

People's Republic of China (PRC) Traditional Chinese Medicine Law

Article 49

The relevant departments of the local people's governments at or above the county level shall, in accordance with the provisions of the state, include qualified medical institutions of traditional Chinese medicine into the scope of designated medical institutions of basic medical insurance, and include qualified Chinese medicine diagnosis and treatment items, Chinese herbal pieces, Chinese patent medicines and Chinese medicine preparations into the payment scope of the basic medical insurance fund.