The latest reimbursement policy for outpatient service in Jinan in 2023.

Medical insurance outpatient reimbursement process is as follows:

1, general outpatient service. The money in the personal medical insurance card can be used to pay, but if the money in the personal medical insurance card runs out, you have to pay for it yourself. Show your social security card to prove your insured identity and registration when you go to a designated hospital for medical treatment. Individuals can be directly reimbursed by social security and hospitals, without having to pay first and then reimburse. Only when the account is settled can the self-paid part be paid by the balance of social security card or cash.

2. Special clinic. Special outpatient service refers to eligible serious diseases and chronic diseases, which can also be reimbursed as hospitalization in outpatient service, because medical insurance only reimburses hospitalization expenses, but some serious diseases and chronic diseases do not necessarily need hospitalization, and can also be treated in outpatient service, so there are special outpatient services. Special outpatient reimbursement needs to be reviewed, and only those who pass the review can enjoy it.

The reimbursement materials are as follows:

1, 18 ID number of the insured;

2. Original invoice of medical expenses (the time limit of medical expenses is within the current medical year and the last medical year);

3. Prescription (drugs need to be priced one by one);

4, medical records (copies) and inspection results;

5. The insured during the grey list period shall also provide an on-the-job retirement audit form.

To sum up, residents can pay directly with the amount of medical insurance card when they see a doctor in the outpatient department. The source of money in the medical insurance card is the money paid by social security every month. The drugs prescribed by doctors can also be paid by social security if they are within the scope of social security. Residents who are seriously ill and need to be hospitalized should show their medical insurance cards and social security cards to the hospital before hospitalization registration. At the same time, it is recommended that doctors try to prescribe drugs within the scope of social security or medical insurance for treatment. In this way, the treatment expenses of seeing a doctor and talking will be reimbursed to a certain extent at the payment office of the hospital. It should be noted that residents' medical insurance will not be reimbursed if they buy medicines themselves or seek medical treatment abroad.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.