The latest regulations of Shaanxi medical insurance reimbursement in 2023

The latest regulations on Shaanxi medical insurance reimbursement in 2023 are as follows:

1, hospitalization reimbursement ratio. 0-90% of them were hospitalized in township hospitals in 300 yuan and 80% in 300 yuan. 0-80% of patients were hospitalized in county hospitals in 500 yuan, and 70% were hospitalized above 500 yuan. 0-70% of the inpatients in municipal hospitals are in 800 yuan, and 60% are in 800 yuan and above. The hospitalization expenses shall be priced by sections and paid monthly. Above the deductible, 55% will be paid as a whole every year.

2. The hospitalization expenses are settled by post-paid service items. In a settlement period, the hospital ranking and medical items are queued for calculation respectively;

3. When the insured is discharged from the hospital, the doctor's advice and outpatient treatment items are selected based on the drugs and medical records, which are reasonably determined by the hospital. The hospital is responsible for the waste caused by excessive medical treatment;

4, outpatient reimbursement ratio. Township hospitals and community health service institutions will be reimbursed 70% for outpatient service, and village clinics and community health service stations will be reimbursed 60%.

Matters needing attention in Shaanxi medical insurance reimbursement in 2023 are as follows:

1. Except for emergency, expenses incurred in non-medical insurance designated medical institutions shall be reimbursed with hospitalization invoices, expense lists and discharge records;

2. Reimbursement ratio: if the hospitalization expenses of medical institutions exceed the self-payment ratio, 70% of the referral and transfer expenses outside the city will be reimbursed;

3, the annual outpatient medical insurance payment has a reimbursement limit;

4. At the time of reimbursement, the outpatient and inpatient medical expenses below the deductible line shall be paid by the individual, the part above the capping line shall be paid by the overall fund, and the outpatient and inpatient medical expenses below the payment limit shall be paid by the individual;

5, the basic medical insurance fund for employees to implement state-level co-ordination, by the state social insurance agencies management, counties and cities no longer set up a separate medical insurance agencies;

6. For reimbursement of hospitalization expenses for cross-regional medical treatment, the insured shall provide the following information: hospitalization invoices, details of hospitalization expenses, discharge records, diagnosis certificates, medical insurance cards, etc.

To sum up, the above are the precautions for Shaanxi medical insurance reimbursement in 2023. Please consult the local social security department for specific policies.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.