Social security medical insurance outpatient reimbursement rate

I. Urban workers Medical insurance 1. Active employees: the outpatient exemption amount is 2,000 yuan, that is, in the medical expenses incurred in the outpatient clinic, the portion of more than 2,000 yuan will be reimbursed, reimbursement rate of 50%; 2. Retired employees: the outpatient exemption amount is 1,300 yuan, that is, in the outpatient clinic incurred in the part of the medical expenses that exceeds 1,300 yuan will be reimbursed, less than 70 years old, the reimbursement rate is 70%, while 70 years old and above, the reimbursement rate is 80%. will be reimbursed. For those under 70 years old, the reimbursement rate is 70%, while for those over 70 years old, the reimbursement rate is 80%. Maximum Limit: The maximum limit for outpatient and emergency large medical expenses is 20,000 yuan, regardless of the type of person. 4、Special Diseases: In a medical insurance year, the exemption amount for outpatient treatment of special diseases is 400 yuan, and the reimbursement rate for medical expenses in line with the scope of prescribed treatment is the same as that for general hospitalization. Urban residents' medical insurance. General outpatient: within one medical insurance year, there is no starting line for general outpatient, and medical expenses within the scope of payment of the outpatient coordinating fund are reimbursed at a rate of 60%, with a maximum individual payment limit of RMB 400 yuan per year for the coordinating fund. 2、Special diseases: within one medical insurance year, the outpatient exemption limit for special diseases is 400 yuan, and the reimbursement ratio of the medical expenses within the scope of treatment in accordance with the regulations is the same as that of the general hospitalization treatment. Third, the new rural medical insurance. 1. 60% reimbursement for village health office and village center health office visits, with a limit of RMB 10 for prescription drug costs per visit and RMB 50 for temporary rehydration prescription drug costs by health center doctors. 2. 40% reimbursement for visits to township health centers, with a limit of RMB 50 yuan per visit for each examination and surgery, and a limit of RMB 100 yuan for prescription drugs. 3. 30% reimbursement for consultation at secondary hospitals, with a limit of RMB 50 yuan for each examination and operation and RMB 200 yuan for prescription drugs. 4. 20% reimbursement for each visit to a tertiary hospital, with a limit of RMB 50 for each examination and operation and RMB 200 for each prescription. 5. Chinese medicine invoices with prescriptions are limited to RMB 1 yuan per sticker. 6. The annual limit of outpatient reimbursement for town-level cooperative medical care is 5,000 yuan. 7、Special Diseases: Within one medical insurance year, the outpatient exemption limit for special diseases is 400 yuan, and the reimbursement ratio of medical expenses in line with the scope of prescribed treatment is the same as that of ordinary inpatient treatment.

Article 29 of the Social Insurance Law of the People's Republic of China (PRC): The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administrative organization with the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a system for the settlement of medical expenses for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons. Article 28 of the Social Insurance Law of the People's Republic of China shall be paid out of the basic medical insurance fund in accordance with the state regulations for medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, as well as those for emergencies and resuscitations.