Guangzhou residents medical insurance outpatient can reimburse how much

Guangzhou residents' medical insurance outpatient reimbursement rate:

The insured patients' medical expenses incurred in the designated medical institutions will be settled directly at the residents' medical insurance settlement counters with the special prescription for medical insurance and social security cards. In an insurance year, the medical insurance fund pays 4O% of the total general outpatient expenses below 50 yuan, and the individual pays for expenses above 50 yuan.

Rural health insurance outpatient reimbursement rate:

(1) 60% reimbursement for village health office and village center health office visits, with a limit of 10 yuan for prescription medicine per visit, and a limit of 50 yuan for temporary rehydration prescription medicine by a doctor at the health center.

(2) Township health centers will be reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.

(3) Secondary hospitals are reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.

(4) Tertiary hospitals are reimbursed 20% of the cost, with a limit of 50 yuan per visit for each examination and surgery and 200 yuan for prescription drugs.

Outpatient medical insurance reimbursement process:

1, the insured person outpatient, hospitalization must present their social security card and swipe the card, outpatient must inform the hospital of the type of consultation (such as outpatient chronic diseases, outpatient special), the failure to present the card or the type of consultation is not clear to inform the insured employee medical treatment medical expenses incurred, the medical insurance fund will not pay;

2, the insured person in the When purchasing medicine at a designated retail pharmacy, the insured person must present his/her citizen card, inform the type of consultation (e.g. outpatient chronic diseases, outpatient specialties), and purchase medicine with the card in accordance with the relevant policies; when purchasing medicine on behalf of another person due to special circumstances, the ID cards of the insured person and the person purchasing on his/her behalf must be presented and registered for the record at the pharmacy;

3. Outpatient care is coordinated through the first-visit and referral system, which is based on the community health service organizations. Participants can make their first visit to the designated community health service organizations or medical institutions that refer to the community management of the basic medical insurance for urban employees; specialized hospitals can serve as the first medical institution for all the participants. If a participant needs to be referred to a medical institution, the first medical institution shall be responsible for the referral, and emergency treatment and rescue are not subject to this limitation. After the limit of outpatient chronic disease subsidy is used up, participants will enjoy outpatient treatment directly from the next payment, and they do not need to be referred to the original outpatient fixed-point medical treatment for chronic diseases. After the limit of outpatient specific item subsidy is used up, outpatient coordinated treatment can only be enjoyed if referrals are made in accordance with the outpatient coordinated treatment regulations and general medical records are used. Drugs purchased at pharmacies are not eligible for the outpatient program.

Summary, social medical insurance is the state and society in accordance with certain laws and regulations, in order to provide protection to the workers within the scope of protection of the basic medical needs of the workers and the establishment of the social insurance system, the government undertakes, and with the help of economic, administrative and legal means of compulsory implementation and organization and management.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug list, diagnostic and therapeutic items, and standards for medical service facilities, as well as those for emergencies and resuscitations, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization 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.