Can medical insurance clinics for urban residents be reimbursed?

"Urban and rural residents can also be reimbursed for going to township hospitals and community service centers to see general clinics." In this regard, the reporter learned about the situation from the Municipal Medical Insurance Bureau. The relevant person in charge of the bureau said that the insured patients of urban and rural residents can go to the town health center and the street community health service center for treatment. They only need to carry their ID cards or social security cards to enjoy the overall treatment of the general outpatient service, and pay the personal part when paying the medical expenses of the outpatient service.

General outpatient co-ordination is a form of medical insurance benefits, which means that the general outpatient expenses of the insured are included in the scope of reimbursement, and the basic medical insurance co-ordination fund and individuals jointly bear the general outpatient expenses, and the outpatient compensation expenses are paid by the outpatient co-ordination fund to compensate the outpatient medical expenses.

According to reports, the insured person can go to the town health center and the street community health service center for outpatient treatment with his ID card or social security card. 50% reimbursement for medical expenses and 70% reimbursement for general medical expenses. There is no limit to the number of visits per year. There is no deductible line and no capping line for outpatient reimbursement. Items with a single inspection exceeding 100 yuan will not be reimbursed.

Urban and rural residents who live and work across districts in this city shall, with their ID cards or social security cards, fill out the "Referral Form for Off-site Residence (Work) of Yangjiang Urban and Rural Residents' Medical Insurance General Clinic" at the town health center (street community health service center) where their household registration is located, go through the transfer formalities for the general clinic, and after being stamped and confirmed by the town health center (street community health service center) to which their household registration belongs, go through the transfer formalities at the town health center (street community health service center) where they live and work, and then go to live. Urban and rural residents who live and work in different places can enjoy the reimbursement of general outpatient treatment in the town health center (street community health service center) where they live and work and the designated village health station within their jurisdiction.

If the insured person lives or works outside the city, he can bring his ID card or social security card, application form for medical treatment in different places, medical invoice (original) and list of expenses (original) back to the medical insurance agency in the insured place to reimburse the general outpatient treatment expenses, and the annual accumulated reimbursement will be made to 50 yuan.

The information required for outpatient reimbursement is as follows:

1, outpatient invoice

2. Outpatient prescription (western medicine does not need a prescription issued by a pharmacy, traditional Chinese medicine needs a prescription, and all kinds of inspection and laboratory bills need to be attached with a report, and the treatment fee will not be reimbursed)

3 copies of medical insurance (the first and second pages are copied on A4 paper).

legal ground

People's Republic of China (PRC) Basic Medical Care and Health Promotion Law

Article 30 The state promotes the implementation of graded diagnosis and treatment system in basic medical services, guides non-emergency patients to give priority to medical treatment in primary health institutions, implements the responsibility system of first diagnosis and referral review, and gradually establishes a mechanism of first diagnosis, two-way referral, fast and slow division of labor and linkage up and down at the primary level, which is linked with the basic medical insurance system.