Chengdu outpatient reimbursement policy in 2022

I. Proportion of social security reimbursement in Chengdu

The proportion of medical insurance reimbursement in Chengdu is divided into three forms: outpatient service, hospitalization and community service.

1. The reimbursement rate of outpatient service in Chengdu is: 200 yuan, 400 yuan, a first-class hospital, 800 yuan, a third-class hospital, a community health service center that meets the requirements and has signed an inpatient medical service agreement with the medical insurance agency 160 yuan, and the referral threshold outside the city is 2,000 yuan. Under any of the following circumstances, the Qifubiaozhun can be reduced or exempted:

If the insured is hospitalized for many times in a natural year, it will be reduced by 100 yuan, but the minimum is not less than 160 yuan;

First, the hospitalization expenses incurred by the insured in designated medical institutions due to mental illness or AIDS that meet the scope of reimbursement of basic medical insurance are not included in the overall fund Qifubiaozhun;

First, the insured who has reached the age of 65 and above, and the hospitalization expenses that meet the scope of reimbursement of basic medical insurance due to illness in designated medical institutions are not included in the overall fund Qifubiaozhun;

1. The insured suffers from malignant tumor surgery, radiotherapy and chemotherapy, renal failure dialysis and transplantation, anti-rejection therapy after liver, kidney and bone marrow transplantation, chronic leukemia and severe aplastic anemia.

The hospitalization expenses of myelodysplastic syndrome, myeloproliferative diseases and systemic lupus erythematosus in designated medical institutions that meet the reimbursement scope of basic medical insurance are calculated once a year. Qifubiaozhun is determined according to the level of the designated medical institution where the insured person lives for the first time in the year;

If the insured person is transferred from a low-grade designated medical institution to a high-grade designated medical institution due to illness, and from a specialized hospital to a general hospital, it will only make up the difference between the overall fund Qifubiaozhun; From a high-level specialized hospital to a general hospital at the same level or lower level, or from a high-level designated hospital to a qualified community health service center, there is no need to calculate the Qifubiaozhun of the overall fund.

Insured persons who have implemented Qifubiaozhun according to the provisions of this article shall pay Qifubiaozhun in accordance with the provisions of the Measures for the Administration of Special Diseases and Family Beds in Outpatient Department of Chengdu Basic Medical Insurance.

2, hospitalization reimbursement ratio is

The deductible line of the first-class hospital is within 200 yuan, and the reimbursement rate is 92%; The deductible line of secondary hospitals is within 400 yuan, and the reimbursement rate is 90%; The deductible line of tertiary hospitals is within 800 yuan, and the reimbursement rate is 85%; The deductible line of community service center in township hospitals is 160 yuan, and the reimbursement rate is 95%; In addition, the insured in Chengdu can increase the proportion of medical reimbursement according to their age. For those over 50 years old, the reimbursement rate will be increased by 2%, for those over 60 years old, by 4%, for those over 70 years old, by 6%, for those over 80 years old, by 8% and for those over 90 years old, by 10%.

Second, the scope of medical insurance reimbursement in Chengdu

1, which meets the prescribed outpatient expenses, including general outpatient service and outpatient treatment for serious and serious diseases;

2, in accordance with the provisions of the hospitalization expenses;

3. Medical expenses such as drug purchase expenses that meet the three catalogues;

Three, Chengdu medical insurance reimbursement process is as follows

1. The agent submits the materials and accepts them;

2. Accept and complete the audit, settlement and payment;

3, the social insurance fund management bureau to review the materials and approve the application;