How much can I apply for medical insurance if the outpatient expenses exceed?

Outpatient expenses can be reimbursed, and reimbursement needs to go to the Social Security Bureau according to the staff tips:

1, 60% reimbursement for visits to village clinics and village center clinics, prescription drug cost limit for each visit 10 yuan, and prescription drug cost limit for temporary rehydration for doctors in health centers in 50 yuan;

2. 40% reimbursement for medical treatment in the town health center, with the limit of 50 yuan for each examination and operation, and the limit of prescription drug 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. Chinese medicine invoice with prescription 1 yuan per paste; The annual limit of outpatient compensation for township-level cooperative medical care is 5000 yuan;

6. immunity. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the provisions of public medical care, and medical expenses that do not conform to family planning; Outpatient treatment fee, visiting fee, hospitalization fee, meals fee, escort fee, nutrition fee, blood transfusion fee (except for family blood storage, which shall be reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ; Within the scope of reimbursement, beyond the limit.

Medical insurance reimbursement conditions are as follows:

1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital;

2. The medical expenses incurred by the insured in the process of medical treatment must conform to the scope and payment standards of the basic medical insurance drug list, medical treatment items and medical service facilities standards, and can be paid by the basic medical insurance fund according to regulations;

3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.

To sum up, outpatient clinics exceeding a certain amount can be reimbursed. Out-patient deductibles are calculated cumulatively for one year. Medical expenses within the scope of the medical insurance policy can be reimbursed according to the regulations when they reach the deductible line in one year, and there is no need to exceed the deductible line every time.

I hope the above content can help you. Please consult a professional lawyer if you have any other questions.

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.

Article 7

The administrative department of social insurance in the State Council is responsible for the national social insurance management, and other relevant departments in the State Council are responsible for the relevant social insurance work within their respective functions and duties.

The social insurance administrative department of the local people's government at or above the county level shall be responsible for the social insurance management within its administrative area, and other relevant departments of the local people's government at or above the county level shall be responsible for the relevant social insurance work within their respective functions and duties.