Guangzhou's new medical insurance reimbursement regulations, the latest policy in 2023

The latest regulations on medical insurance reimbursement in Guangzhou in 2023 are as follows:

1, general outpatient service. In 2023, the new medical insurance regulations will further increase the proportion of general outpatient visits, reduce the threshold fees and increase the proportion of reimbursement. Community hospitals are reimbursed 60%, and other medical institutions are reimbursed 40%. The annual reimbursement limit has been raised from 300 years to 450 years.

2. Hospitalization. The proportion of hospitalization reimbursement increased, and the threshold fee decreased. The minimum reimbursement rate reaches 90%.

3. Fertility. The proportion of reimbursement for childbirth has increased, with 50% for prenatal examination and 80% for childbirth.

4. Outpatient specific diseases. There are 27 outpatient specific diseases in Guangzhou, and the reimbursement rate is as high as 90%. The maximum reimbursement is 450,000.

5. Medical insurance catalogue. B drugs, diagnosis and treatment projects do not set the proportion of individual pays; Class A drugs are paid by individuals 10%, and class B drugs and treatment items are paid by individuals 25% and 45%.

Medical insurance reimbursement materials:

1, medical insurance card: hold a valid medical insurance card;

2. Medical records: medical records are needed, including the department, date, diagnosis result and treatment plan.

3. Prescription note: the original and photocopy of the prescription note are required, including the name, dosage, usage and time of use of the drug;

4. Receipt: the original and photocopy of the receipt for drug purchase or treatment expenses shall be provided, including the name, quantity, unit price and amount of the drug;

5. Hospitalization records: In case of hospitalization, hospitalization records, discharge summary and other hospitalization records shall be provided;

6. Other relevant materials: such as outpatient medical bills, inpatient medical bills, inspection reports issued by hospitals, laboratory tests, etc.

To sum up, the medical insurance reimbursement process may be slightly different in different regions, and the specific operation steps can be adjusted according to local policies and actual conditions.

Legal basis:

Article 2 of People's Republic of China (PRC) Social Insurance Law

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

essay

The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.