What is the reimbursement rate of special outpatient

Special outpatient reimbursement rates are as follows:

1. Active employees are reimbursed at 80%, while retirees are reimbursed at 85%.

2. The reimbursement rate for basic health insurance for urban workers is 85%, with an increase of 2% for those who have reached the age of 50, a boost of 4% for those who are 60 years old, 6% for those who are 70 years old and 8% for those who are 80 years old and above, with reimbursement rates within 100%.

3. In the urban and rural residents' health insurance, the reimbursement rate for the low-tier contribution and students and children is 50%, and the reimbursement rate for the high-tier contribution is 65%.

4. The reimbursement rate for outpatient major illnesses is 95% for medical expenses above the maximum payment limit of the Basic Medical Care Coordination Fund of more than 80,000 yuan, 90% between 40,000 yuan and 80,000 yuan, and 85% for medical expenses below 40,000 yuan.

Required materials for reimbursement of special outpatient services:

1. Application form for outpatient special diseases and treatment programs, which should be filled out by a physician of the relevant specialty with the title of attending (including attending) or above in a designated hospital of the second level or above, and examined and stamped by the medical insurance office;

2. Relevant medical records, including description of the condition, treatment process, etc.

3. Relevant examination and test reports to prove the condition and the necessity of treatment;

4. Discharge summary, if there is any hospitalization;

5. ID card, social security card or medical card of the insured person, used to verify the identity of the insured person;

6. Regular receipts of medical expenses, to prove that the medical expenses have been incurred;

7. Other supporting materials that may be required, according to the local medical insurance policy. Supporting materials, which may vary according to local health insurance policies and specific disease types.

In summary, the reimbursement rates for active employees and retirees are 80% and 85% respectively. The reimbursement rate for urban workers' basic medical insurance increases gradually according to age, up to a maximum of 100%. In the urban and rural residents' medical insurance, the reimbursement rate for lower-tier contributions and students and children is 50%, and the reimbursement rate available for higher-tier contributors is 65%.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 29

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