Is there a cap on outpatient reimbursement

There is an upper limit to the reimbursement of outpatient co-ordination.

The following is a description of the reimbursement rate and reimbursement cap for outpatient reimbursement in general:

1. Reimbursement rate: outpatient reimbursement will generally reimburse a certain percentage of the medical expenses, and the specific percentage varies from region to region, generally ranging from 50% to 90%. For example, if the reimbursement rate for an outpatient program in a certain region is 70%, then eligible patients can get 70% reimbursement of their medical expenses;

2. Reimbursement ceiling: The outpatient program has a reimbursement ceiling for each type of medical expenses, that is, the maximum amount of reimbursement for each time. Specific reimbursement ceilings vary according to regions and medical items. In general, the reimbursement ceilings range from a few hundred dollars to more than a thousand dollars; for example, if the reimbursement ceiling for a certain medical item under the Outpatient Pool in a certain region is 500 dollars, the maximum reimbursement for that item will not be more than 500 dollars.

The significance of the implementation of the outpatient co-ordination system of medical insurance is as follows:

1. Outpatient co-ordination reflects the requirements of mutual assistance ****** of social insurance, and is conducive to improving the utilization rate of social security funds;

2. Outpatient co-ordination enhances the fairness of social insurance, and is conducive to improving the attractiveness of social security and alleviating the burden of outpatient expenses on the participants;

3. The establishment of an outpatient co-ordination system It is conducive to giving full play to the role of social insurance in regulating medical services, optimizing services, and promoting early prevention and treatment;

4. The establishment of a medical insurance co-ordination system can expand the universality of basic medical insurance, and enhance the ****ancial nature of the medical insurance fund.

In summary, outpatient co-ordination reimbursement policies vary from region to region, and specific reimbursement rates and reimbursement ceilings may also vary. It is recommended to read the relevant local policies and regulations carefully before using the outpatient co-ordination reimbursement to understand your reimbursement rate and reimbursement ceiling, so as to make better use of the health insurance policy.

Legal basis:

Article 11 of the Social Insurance Law of the People's Republic of China

Basic pension insurance is a combination of social coordination and individual accounts.

The basic pension insurance fund consists of contributions from employers and individuals and government subsidies.

Article 19

If an individual is employed in a cross-coordinated area, his or her basic pension insurance relationship shall be transferred with him or her, and his or her years of contribution shall be cumulative. When an individual reaches the legal retirement age, the basic pension is calculated in segments and paid uniformly. The specific measures shall be prescribed by the State Council.

Article 52

If an employee is employed across the integrated areas, his unemployment insurance relationship shall be transferred with him and his contribution years shall be cumulative.