Proportion of reimbursement for special outpatient service of medical insurance for employees in Guangzhou

Proportion of reimbursement for medical insurance outpatient service for employees:

Employees can only be reimbursed for medical expenses of more than 2,000 yuan after going to the hospital for emergency treatment, and the reimbursement ratio is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.

Two, residents' medical insurance outpatient reimbursement ratio:

Outpatient settlement procedure: Insured patients will pay the medical expenses incurred in the outpatient service of designated medical institutions directly by swiping the card at the resident medical insurance settlement counter with the special medical insurance prescription and social security card. In an insurance year, if the total outpatient expenses are below 50 yuan, the medical insurance fund will pay 40%, and the expenses above 50 yuan will be borne by individuals.

Three, rural medical insurance outpatient reimbursement ratio:

1, 60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.

2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription fee 100 yuan.

3, the secondary hospital reimbursement of 30%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.

4, tertiary hospital reimbursement of 20%, each visit examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.

5. Traditional Chinese medicine invoices are accompanied by prescriptions, with a limit of 1 yuan.

6, the township cooperative medical outpatient compensation limit is 5000 yuan.

Proportion of reimbursement for outpatient special diseases

Medical insurance for employees: within a medical insurance year, the reimbursement rate of medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization. In 400 yuan, the deductible line of special disease outpatient service.

Medical insurance for urban and rural residents: within a medical insurance year, the proportion of reimbursement for medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization. In 400 yuan, the deductible line for special disease clinics.

At present, outpatient special disease 12.

1, malignant tumor;

2, uremia outpatient renal dialysis;

3. Outpatient treatment after tissue and organ transplantation;

4. Organ failure (heart, lung, liver, kidney); (5) Recovery period of cerebrovascular accident;

5, hypertension phase III (one of the complications of heart, brain, kidney and eye;

6. Diabetes (complicated with infection or complications of heart, kidney, eyes and nervous system);

7. Chronic aplastic anemia;

8. Systemic lupus erythematosus (one of the complications of heart, lung, liver, kidney and nervous system);

9. Severe mental disorder;

10, hemophilia; (12) Chronic hepatitis B (active hepatitis B), hepatitis B cirrhosis and chronic hepatitis C (17 data from a certain place)

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.