How much can be reimbursed for outpatient medical insurance

1, active employees, after visiting the outpatient and emergency room of the hospital, only medical expenses over 1800 yuan can be reimbursed, and the reimbursement rate is 50%.

2. If you are a retiree under the age of 70, you can be reimbursed for expenses above 1,300 yuan, and the reimbursement rate is 70 percent.

3. If the retiree is over 70 years old, the expenses above $1300 can be reimbursed the reimbursement rate is 80 percent.

After the emergency reimbursement method:

1, medical insurance card direct reimbursement: If I can carry a medical card when I go to the doctor, use the medical card for registration and consultation, etc., can be directly bound with the medical insurance system, the hospital in the accounting for the payment of the fee, can be real-time settlement of the medical insurance, we only need to pay the corresponding cost after deduction.

2, offline reimbursement: If you do not carry a social security card when you visit the clinic, then you can only be reimbursed offline after the clinic, the general offline insurance, the user carries a good hospital payment invoice, medical checklist, medical records, medical certificates and other materials, go to the local social security centers, fill out the information and submit according to the requirements, to be audited and approved, the reimbursement amount will be automatically issued to the medical insurance bonded to the bank account of the card.

The hospitals will be able to provide you with the information you need.

The reimbursement rates for different statuses of hospital emergency medical insurance are as follows:

Students, children:

In a billing year, the incidence of medical expenses under 180,000 yuan eligible for reimbursement, the starting standard of the third-level hospitals is 650 yuan, reimbursement rate of 50%, the upper limit of 2,000 yuan; the second-level hospitals starting standard of 300 yuan, reimbursement rate of 60%; the first-level hospitals do not set a starting standard, reimbursement rate of 60%. hospitals do not have a starting standard, the reimbursement rate is 65%.

Over 70 years old and above:

In a settlement year, if you have incurred medical expenses of less than 100,000 RMB that are eligible for reimbursement, the minimum payment standard of a tertiary hospital is 650 RMB, the reimbursement rate is 50%, and the maximum payment standard is 2,000 RMB; the minimum payment standard of a secondary hospital is 300 RMB, the reimbursement rate is 60%; and the reimbursement rate for a primary hospital is 65% without any minimum payment standard.

Other urban residents:

In a billing year, for medical expenses of less than 100,000 yuan that are eligible for reimbursement, the starting standard for third-level hospitals is 659 yuan, and the reimbursement rate is 50% with an upper limit of 2,000 yuan; the starting standard for hospitalization in second-level hospitals is 300 yuan, and the reimbursement rate is 55%; and first-level hospitals don't have any starting standard, and the reimbursement rate is 60%.

Emergency settlement procedures:

Participants due to emergency rescue to the city's non-designated medical institutions and off-site medical institutions hospitalization, medical expenses incurred by the individual or the unit advance, emergency rescue after the end of the emergency, with the hospital emergency medical records, inspection, laboratory reports, invoices, a detailed list of medical charges and so on to the medical insurance agency for reimbursement in accordance with the provisions of the procedures.

Legal basis:

The People's Republic of China Social Insurance Law

Article 25 The State establishes and improves the basic medical insurance system for urban residents.

Basic medical insurance for urban residents is a combination of individual contributions and government subsidies.

The government shall subsidize the portion of individual contributions required by those who are entitled to the minimum subsistence guarantee, persons with disabilities who have lost their ability to work, and elderly persons and minors over sixty years of age from low-income families.

Article 28 The medical expenses in line with the basic medical insurance drug list, diagnostic and treatment items, medical service facility standards, as well as emergency and rescue, shall be paid from the basic medical insurance fund in accordance with national regulations.