Jilin province health insurance outpatient reimbursement new regulations 2023 latest

The new regulations on outpatient reimbursement of health insurance in Jilin Province for 2023 are as follows:

1. For active employees, after visiting outpatient and emergency clinics of hospitals, only medical expenses of more than 1,800 yuan can be reimbursed, and the reimbursement rate is 50%;

2. For retirees under 70 years old, expenses of more than 1,300 yuan can be reimbursed, and the reimbursement rate is 70%; and retirees aged 70 years old For retirees over 70 years old, the reimbursement rate is 70% for expenses over 1,300 yuan; for retirees over 70 years old, the reimbursement rate is 80% for expenses over 1,300 yuan.

But the medical insurance will not pay for the following cases:

1. medical treatment in non-designated medical structures or purchase of medicines in non-designated retail pharmacies (except for emergencies);

2. medical treatment due to alcoholism, suicide, self-inflicted injuries, etc.

3. injuries due to traffic accidents, medical malpractice, or other accidents;

4. injuries due to fighting, drug addiction, or other illegal acts;

5. injuries due to the use of drugs, drugs or other illegal acts;

6. injuries due to the use of drugs. Fighting and assault, drug addiction or other illegal behaviors that cause their own injuries;

5, and cases that should be paid by the individual according to national or local regulations.

The documents you need to bring with you for reimbursement of medical insurance are as follows:

1. The original ID card or social security card;

2. The original diagnostic certificate of disease issued by a specialist doctor of the designated medical institution;

3. The original medical documents such as outpatient medical records, report cards of examination and test results;

4. The original receipt of outpatient fee of the unified medical institution for finance and taxation;

5. The original fee receipt;

5. The original computer-printed list of outpatient expenses or the original payer's prescription issued by the doctor;

6. Designated pharmacies: the original unified invoice for the sale of tax commodities and the original computer-printed list;

7. If you are applying for the procedure on behalf of someone else, you will need to provide an original ID card of the person who is doing it on behalf of the person.

In summary, bring all the above information to the relevant departments of the local social security center to apply for processing, after review, complete information, eligible for immediate processing. When the applicant applies for reimbursement of outpatient medical expenses, the amount transferred to the individual account of medical insurance in the current social security year will be deducted first, and then the amount to be reimbursed will be approved.

Legal basis:

Article 29 of the Social Insurance Law of the People's Republic of China

The portion of a participant's medical expenses that should be paid for by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.