Upper limit of outpatient medical insurance reimbursement in Guangzhou

Upper limit of reimbursement amount for general outpatient service of medical insurance in Guangzhou

Employee medical insurance: 300 yuan/month;

Minors and students in residents' medical insurance: 1000 yuan/month;

Medical insurance for other urban and rural residents: 600 yuan/month.

First, medical insurance for urban workers:

1. On-the-job employees: the deductible for outpatient service is 2000 yuan, that is, the medical expenses incurred in outpatient service that exceed 2000 yuan will be reimbursed, and the reimbursement ratio is 50%;

2. Retired employees: The outpatient service fee is 1.300 yuan, that is, only the part that exceeds 1.300 yuan is reimbursed, with 70% for those under 70 years old and 80% for those over 70 years old.

3. Maximum amount: No matter what kind of people, the maximum amount of outpatient and emergency medical expenses is 20,000 yuan.

Two, medical insurance for urban residents:

1. general outpatient service: in a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund are reimbursed at the rate of 60%. The maximum annual payment limit for individuals of the overall fund is 400 yuan.

2. Special diseases: In a medical insurance year, the deductible for outpatient service of special diseases is 400 yuan, and the proportion of reimbursement for medical expenses meeting the prescribed treatment scope is the same as that for general hospitalization.

Three, the new rural cooperative medical insurance:

1, 60% of the medical expenses of village clinics and village center clinics are reimbursed, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration of hospital doctors is 50 yuan. 2. Reimbursement of 40% for medical treatment in town health centers, with the limit of examination fee and operation fee for each visit, and the limit of prescription fee 100 yuan.

3, the secondary hospital reimbursement of 30%, each examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.

4, tertiary hospital reimbursement of 20%, each visit examination fee and operation fee limit 50 yuan, prescription drug fee limit 200 yuan.

5. Traditional Chinese medicine invoices are accompanied by prescriptions, with a limit of 1 yuan. 6, the township cooperative medical outpatient compensation limit is 5000 yuan.

7. Special diseases: In a medical insurance year, the deductible for outpatient service of special diseases is 400 yuan, and the proportion of reimbursement for medical expenses that meet the prescribed treatment scope is the same as that for general hospitalization.

Outpatient medical insurance reimbursement process:

1. For outpatient and inpatient treatment, the insured person must show his social security card and swipe his card for medical treatment. The outpatient department must inform the hospital of the treatment category (such as chronic disease and outpatient service). If the card card is not produced or the treatment category is not clear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance fund;

2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the treatment category (such as outpatient chronic diseases, special), according to the relevant policies to buy drugs, because of special circumstances by others purchasing drugs, must show the insured and the purchaser's identity card, and registered by the pharmacy;

3, outpatient co-ordinate the implementation of the first diagnosis and referral system based on community health service institutions. Insured persons can be first diagnosed or referred to community-managed medical institutions in designated community health service institutions for urban workers' basic medical insurance; Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs a referral, the first-visit medical institution shall be responsible for the referral, and emergency rescue is not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, you can directly enjoy the outpatient co-ordination treatment from the next cost, without referring to the original chronic disease. After the subsidy limit for specific outpatient items is used up, the referral procedures must be handled according to the provisions of outpatient co-ordination, and ordinary medical records can be used to enjoy the outpatient co-ordination treatment, but drugs bought in pharmacies do not enjoy the outpatient co-ordination treatment.

To sum up, social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. It is undertaken by the government and implemented and managed by economic, administrative and legal means.

To sum up, it is Bian Xiao's relevant answer about the reimbursement ceiling of Guangzhou medical insurance outpatient service, hoping to help you.

Legal basis:

Measures for the implementation of outpatient economic security of basic medical insurance for employees in Guangdong Province

Fourth general outpatient co-ordination through the overall fund to ensure that the insured meet the requirements of the general outpatient medical expenses. There is no qifubiaozhun for general outpatient service of employee medical insurance. Within the scope of the policy, the proportion of medical expenses incurred by employees shall be not less than 60% in the first-level and below medical and health institutions, not less than 55% in the second-level medical and health institutions, and not less than 50% in the third-level medical and health institutions, and the proportion of retirees shall be appropriately increased; The annual maximum payment limit is not less than 2% of the average annual salary of urban workers in the previous year. To be listed at the local level, it is necessary to scientifically calculate and reasonably determine the payment ratio and the maximum payment limit in combination with the actual situation in the region and within the specific policy scope of coordinating the general outpatient service of employee medical insurance. Simultaneously improve the overall treatment of urban and rural residents' basic medical insurance general outpatient service, and gradually improve the level of protection.