Proportion and amount of reimbursement for general outpatient service

The proportion and amount of reimbursement for general outpatient services vary with different regions and medical insurance systems. Please consult the local social security bureau or medical insurance center for specific information.

The medical insurance system in China is divided into three types: basic medical insurance for urban workers, basic medical insurance for urban residents and new rural cooperative medical care. Each kind of medical insurance has corresponding reimbursement scope, proportion and limit. Taking the basic medical insurance for urban workers as an example, according to the provisions of the Social Insurance Law, the reimbursement scope of the basic medical insurance for urban workers includes hospitalization, outpatient medical treatment, medical treatment for special diseases, etc. The proportion and limit of outpatient medical reimbursement vary from region to region. For example, the reimbursement rate of medical insurance outpatient service for employees in Beijing is 80%, the reimbursement limit of drugs in secondary hospitals is 60 yuan, and the reimbursement limit of tertiary hospitals is 100 yuan; In Shenzhen, the reimbursement rate of medical insurance outpatient service for employees is 70%, the reimbursement limit of common drugs is 10 yuan, and the reimbursement limit of medical expenses is 50 yuan. In addition, the scope, proportion and limit of outpatient reimbursement for different types of insurance are not the same. For example, the reimbursement rate of urban residents' medical insurance clinics is generally between 50% and 80%, and the limit is about 100 yuan; The reimbursement rate of outpatient service of the new rural cooperative medical system is between 50% and 90%, and the limit is generally below that of 300 yuan.

What should I do if I exceed the reimbursement limit? If the outpatient medical expenses exceed the reimbursement limit of medical insurance outpatient service, the excess can be paid in accordance with the provisions of the place where the patient is treated. You can also choose to purchase commercial medical insurance for supplementary protection, and some commercial insurance products may reimburse expenses exceeding the medical insurance limit.

The proportion and limit of medical insurance reimbursement for general outpatient clinics vary with different regions and medical insurance systems, and it is necessary to negotiate according to local specific conditions. At the same time, the public can also consult the front desk staff or the staff of the social security card service station to obtain relevant information on outpatient reimbursement when seeking medical treatment, so as to know fairly well and avoid unnecessary cost losses.

Legal basis:

"People's Republic of China (PRC) Social Insurance Law" Article 28 The basic medical insurance benefits for employees participating in the basic medical insurance include outpatient service, hospitalization, childbirth, family planning operation, serious illness, hospice care and other items.