Xi outpatient reimbursement deductible line

Xi outpatient reimbursement deductible line is as follows:

In 2023, the deductible standard for reimbursement of outpatient medical insurance for urban and rural residents in Xi is: within one year, the cost of diagnosis and treatment of chronic diseases exceeds that of 500 yuan, that of two diseases exceeds that of 700 yuan, and that of three diseases exceeds that of 900 yuan. Within the scope of medical insurance, the medical insurance fund will be reimbursed by 60%, with an annual cumulative reimbursement limit of 3,000 yuan. The diseases reimbursed by the outpatient department for serious diseases include malignant tumors, anti-rejection treatment after organ transplantation and long-term hemodialysis diseases. If the outpatient medical expenses exceed the deductible line, the medical insurance fund will pay 70%, and the expenses will be combined with the hospitalization expenses of this year, which will not exceed the prescribed maximum limit.

Social security reimbursement policy:

1. Reimbursement scope: covering outpatient treatment, drug expenses, outpatient expenses for special diseases, etc.

2. Deductible standard: Different regions and different types of social security plans will have different deductible standards;

3. Reimbursement proportion: usually reimbursed according to a certain proportion, and the proportion varies according to different social security schemes;

4. Cap line limit: after the reimbursement amount reaches a certain amount, the excess will not be reimbursed;

5. Designated medical institutions: reimbursement usually requires treatment in designated medical institutions;

6. Personal account use: In some areas, personal medical insurance accounts are allowed to pay part of the expenses to lower the threshold of deductible.

To sum up, in 2023, the deductible line of outpatient medical insurance reimbursement for urban and rural residents in Xi will surpass 500 yuan for one disease, 700 yuan for two diseases and 900 yuan for three diseases. The medical insurance fund is reimbursed by 60% within the scope, and the serious illness is reimbursed by 70%. The outpatient and hospitalization expenses are calculated together, and the annual cumulative reimbursement limit is 3,000 yuan.

Legal basis:

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

Article 27

Employers who pay the basic medical insurance premiums in accordance with these regulations enjoy the basic medical insurance benefits.

Article 28

Personal accounts are used to pay medical expenses beyond the scope of the overall fund payment; If the personal account is insufficient to pay, it shall be borne by me.

Article 29

The hospitalization expenses for major diseases are paid in the following ways:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.

The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.

People's Republic of China (PRC) social insurance law

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.