Proportion of reimbursement for outpatient medical insurance in Taizhou city

First, the proportion of reimbursement for employees' medical insurance clinics;

After the on-the-job employees see a doctor in the outpatient and emergency department of the hospital, the medical expenses of more than 2,000 yuan can be reimbursed, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.

Two, residents' medical insurance outpatient reimbursement ratio:

Outpatient settlement procedure: Insured patients will pay the medical expenses incurred in the outpatient service of designated medical institutions directly by swiping the card at the resident medical insurance settlement counter with the special medical insurance prescription and social security card. In an insurance year, if the total outpatient expenses are below 50 yuan, the medical insurance fund will pay 40%, and the expenses above 50 yuan will be borne by individuals.

Three, rural medical insurance outpatient reimbursement ratio:

1, 60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan.

2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription 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.

3, tertiary hospital reimbursement 20%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan. Chinese medicine invoice with prescription, limit 1 yuan. The annual compensation limit for rural cooperative medical clinics is 5000 yuan.

Legal basis:

Article 28 of the Social Insurance Law

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.

Article 29

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.