New Deal of Medical Insurance Reimbursement in Henan Province in 2023

The new policy of medical insurance reimbursement in Henan Province in 2023 is as follows:

1, improvement of general outpatient treatment: the reimbursement standard of residents' medical insurance outpatient service has been improved, and the reimbursement standard of hypertension and diabetes has been improved.

2. The treatment of chronic diseases and special diseases in outpatient clinics is fairer: the province unifies the identification standards of chronic diseases and special diseases in outpatient clinics, and incorporates hypertension and diabetes into the management of chronic diseases and special diseases in outpatient clinics.

3. Hospitalization treatment is higher: the payment ratio is higher, the deductible line is lower, and the capping line is gradually cancelled.

4. Fairer medical security: it is clear that legal persons, child care institutions, nursing institutions and other insured persons are fully filed, and the functions of outpatient co-ordination and outpatient chronic diseases and special diseases are brought into play.

5. It is more convenient to enjoy treatment: manual reimbursement is clear and standardized, and medical insurance benefits are paid in stages.

6. The medical insurance fund is safer: clearly strengthen the supervision of the medical insurance fund and clearly strengthen the management of the medical insurance agreement.

The reimbursement process of hospitalization medical insurance is as follows:

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution. When in hospital, the individual pays the deposit of medical expenses in advance, and pays more and less after discharge. Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be presented to the medical insurance management window the next day after admission (postponed in case of holidays), and the overdue medical expenses should be borne by themselves;

2. The deductible line of the overall fund after the insured person is hospitalized: the deductible line varies from place to place, which is generally 10% of the average annual salary of employees in the whole city in the previous year. In a basic medical insurance settlement year, the cumulative calculation of medical expenses for multiple hospitalizations;

3. If the insured person needs to be referred or transferred due to illness, the deputy chief physician or chief physician of the designated medical institution at or above the third level shall put forward the opinions of referral (hospital) after diagnosis, and the unit to which he belongs shall fill in the application form and go through the referral (hospital) formalities with the approval of the medical insurance management department of the designated medical institution. The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

4. When the designated medical institutions are discharged from the hospital, the designated medical institutions will calculate the reimbursement amount of medical insurance and the amount that individuals should pay. The reimbursement amount will be settled by the designated medical institutions and urban social insurance agencies, and the amount that individuals should pay will be settled by the designated medical institutions and the insured.

Medical insurance reimbursement materials are as follows:

1, hospitalization invoice;

2. Discharge certificate;

3, hospitalization expenses and medication list;

4. A copy of the household registration book or ID card;

5, the new rural medical insurance certificate;

6. The social security designated hospital certificate of the inpatient hospital.

To sum up, when citizens are reimbursed for medical insurance in Henan, the insured can reimburse them at designated medical institutions and retail pharmacies with medical insurance cards. Henan medical insurance reimbursement is mainly divided into outpatient reimbursement and hospitalization reimbursement, and the reimbursement methods in these two cases are also different.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.