How much is outpatient medical insurance reimbursement?

There are two kinds of outpatient medical insurance reimbursement, and the reimbursement standards are as follows:

1, residents' medical insurance:

In an insurance year, if the general outpatient expenses of insured residents in designated outpatient medical institutions are less than 100 yuan, the residents' medical insurance fund will pay 30%, and individuals will pay 70%; Personal consumption exceeds 100 yuan.

2, medical insurance for urban workers:

Not all the personal accounts on the medical insurance card of the insured person insured by the unit are paid by themselves. Since last year, the medical insurance card of flexible employees has also had a personal account, with a monthly amount of 15 yuan, which can be used to pay outpatient expenses, which is equivalent to outpatient reimbursement, unless the insured person belongs to a civil servant or the unit has another reimbursement policy.

Medical insurance hospitalization, show medical insurance card, read the card into the medical insurance system, and pay the deposit is generally a threshold fee. The expenses incurred are entered into the system, and the system automatically classifies them as self-funded, Class A, Class B, etc. Class B pays 65,438+00% first, and then enters the basic medical care. If the number of hospitalizations per year is greater than 1, the threshold fee will be halved, and the proportion of overall planning will be different for different hospital levels. The computer figured out how much it should pay.

Medical insurance reimbursement process in different places:

1, medical treatment in different places needs to be approved by relevant departments first. The examination and approval place for resettlement in different places is the county medical insurance center where the insured unit or street social security is located. After applying for the relevant approval form, fill in the relevant contents. Take the relevant documents to the medical insurance department of a different hospital and stamp them. Then return the relevant approval form to the applicant for approval;

2. The time limit for examination and approval in different places is generally one year, that is, from the date of handling to the date of the second year. You can't change it within a year. If the approval period has passed, the parties who are still in different places need to go to the relevant departments for re-approval. For the parties in different places, it is essential to choose a different hospital. The regulations on how many hospitals patients can choose in different regions are different. Generally, you can choose two or three;

3. It is essential for people who seek medical treatment in different places to meet reimbursement in different places. Relevant personnel need to go to outpatient department and hospital to issue receipts, lists, prescriptions, details, medical insurance manuals and case diagnosis certificates. The more detailed, the better.

4. For the medical expenses incurred by the parties in designated hospitals in different places, mail the relevant reimbursement documents back to the original city for reimbursement, or ask family members to help with reimbursement in the original city. Issues such as reimbursement standards will still be in accordance with the regulations of the city, and relevant funds can be collected by family members or related accounts can be set up.

In summary, the proportion of outpatient reimbursement. There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. Within 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 payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan.

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.