Can the expenses from the outpatient department be reimbursed?

The expenses paid by the outpatient department can be reimbursed.

After seeing a doctor in the outpatient department, the insured person needs to bring his own medical records, insurance vouchers, expense lists and other materials to the hospital settlement window for direct settlement, and some self-funded and self-funded hospitals will not be reimbursed. The hospital only reimburses the expenses within the medical insurance drug list.

1, outpatient reimbursement ratio:

(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.

(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.

(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.

(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.

(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan. 2. Hospitalization reimbursement: 60% reimbursement for town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

How to reimburse the medical insurance card clinic:

1, residents' medical insurance:

In an insurance year, if the general outpatient expenses of insured residents in designated outpatient medical institutions are within 100 yuan (inclusive), the residents' medical insurance fund will pay 30% and individuals will pay 70%; Personal consumption exceeds 100 yuan.

2, medical insurance for urban workers:

The personal account on the medical insurance card of the insured person insured by the unit is not paid by himself; Since last year, the medical insurance card of flexible employees also has a monthly personal account of 15 yuan, which can be used to pay outpatient expenses, which is equivalent to outpatient reimbursement (unless the insured belongs to civil servants or the unit has another reimbursement policy).

Medical insurance hospitalization, show the medical insurance card, read the card into the medical insurance system, pay the deposit (usually the threshold fee), and enter the fee into the system. The system automatically classifies it as self-funded, Class A, Class B, etc. Class B should pay 10% first, and then enter the basic medical care. According to the annual number of inpatients (more than 1 threshold fee halved), hospital level (different threshold fees, overall planning,

To sum up, after seeing a doctor in the outpatient department, the insured person needs to bring his medical record, insurance voucher, expense list and other materials to the hospital settlement window for direct settlement, and some self-funded and self-funded hospitals will not be reimbursed. The hospital only reimburses the expenses within the medical insurance drug list.

Legal basis:

Article 29 of People's Republic of China (PRC) Social Insurance Law

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.