Social security card outpatient reimbursement scope

The coverage of outpatient medical insurance is as follows:

1, drug reimbursement for basic medical insurance:

(1) The basic medical insurance drugs are divided into Class A and Class B ... Class A drugs refer to drugs that are basically unified throughout the country and can ensure the basic needs of clinical treatment. The expenses of such drugs are included in the payment scope of the basic medical insurance fund, and the expenses are paid according to the basic medical insurance payment standard;

(2) The list of Class B drugs shall be adjusted by the provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions. Before such drugs are included in the payment scope of the basic medical insurance fund, the employees shall pay according to a certain proportion and pay according to the basic medical insurance payment standard.

(3) The following drugs do not belong to the reimbursement scope of basic medical insurance: drugs that mainly play a nourishing role; Some animals and animal organs that can be used as medicine, such as dried fruits; Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces; Fruit-flavored preparations and oral effervescent agents in various drugs; Blood products and protein products, except for special indications and first aid and rescue; Other drugs that are not paid by the basic medical insurance fund as stipulated by the administrative department of social insurance.

2, the basic medical insurance treatment project shall meet the following conditions:

(1) Clinical diagnosis and treatment must be safe and effective, and the cost should be appropriate;

(2) The price department has set the charging standard;

(3) within the scope of designated medical services provided by designated medical institutions for the insured.

3. The reimbursement scope of medical service facilities of basic medical insurance includes the living service facilities provided by designated medical institutions and necessary for the insured in the process of diagnosis and treatment and nursing, mainly including the hospitalization bed fee or outpatient (emergency) observation bed fee. The basic medical insurance fund does not pay for living services and service facilities, mainly including:

(1) Transportation expenses for referral and first aid;

(2) Air conditioning fee, TV fee, telephone fee, baby incubator fee and food incubator fee;

(3) Escort fee, nursing fee, washing fee and outpatient decocting fee;

(4) meals;

(5) Hospitality and other special life service expenses.

The reimbursement ratio of outpatient medical insurance is as follows:

1, 1300 yuan to 10000 yuan for reimbursement of 80%;

2, 10000 yuan to 30000 yuan (inclusive) can be reimbursed 85%;

3, 30 thousand yuan to 40 thousand yuan (inclusive) reimbursement of 90%;

4, more than 40 thousand yuan reimbursement of 95%.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).

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.