Can't get reimbursed if you don't pick a spot? Do I need to select a point if I don't visit the doctor across districts? Foshan health insurance new policy to answer questions →

The new policy of Foshan City Basic Medical Insurance "outpatient ****Ji" has been formally implemented on November 1

Realizing the long-awaited "cross-district medical treatment"

Reimbursement costs have also been further improved

About the new policy

A

The insured person to enjoy the general outpatient treatment needs to be selected first designated medical institutions (except emergency, rescue), in principle, the insured person only need to "complete the selection of the point before registering" to enjoy the health insurance treatment, if there is no need to see a doctor, designated hospitals can be selected, you can choose to see a doctor again, but you need to have a point of selection before enjoying the treatment.

Q

2. The new policy will be implemented from November 1, before the point of selection, is it considered valid?

A

November 1, 2022 before the selection of points for the pre-selection of points for the period, the participants can be in this period in advance of the selection of points, November 1, the selection of points formally effective.

Q

3. Is it true that if I don't select a point, I won't be able to enjoy health insurance reimbursement?

Q

3. Is it true that you can't get reimbursed if you don't choose a location?

A

Participants enjoying the general outpatient treatment of health insurance need to select no more than three designated medical institutions in the city, of which at least one must be a primary care institution.

However, the following cases of general outpatient treatment in non-selected medical institutions are eligible for reimbursement:

1. Emergency and rescue. In the city, outside the city of the medical institutions incurred in accordance with the provisions of the cost can be reimbursed, the relevant health insurance fund to pay the amount included in the basic health insurance fund annual cumulative maximum payment limit.

2. Referral. Participants can be referred by the selected medical institutions, within 30 days to the non-selected medical institutions incurred within the scope of the policy of medical expenses, according to the level of the transfer to the corresponding level of medical institutions to pay the proportion. For example, if the referred medical institution is a secondary medical institution, the reimbursement will be based on 70% of the rate of the secondary medical institution.

Q

4. Is it possible to choose three districts to locate and visit any of the designated medical institutions in these three districts and enjoy outpatient medical insurance reimbursement?

Answer

You can choose a spot across the district. According to the relevant provisions of the province, "the insured person in principle to select a designated medical institutions, generally a year certain", the insured person must be in the selected designated medical institutions in order to enjoy the medical insurance reimbursement. The city's optimization policy for the number of fixed-point medical institutions not more than 3, of which at least 1 selected primary health care institutions.

Q

5. How can I change the wrong selection point?

A

The selection point can be changed 3 times per year (1 change is 1 time). Use WeChat "Sweep" to enter the "Guangdong Medical Insurance" WeChat small program, click on the "outpatient election point registration", and follow the prompts.

Check the information of the selected point and click "Change" to re-select the point.

About reimbursement

Q

1. Is it true that I can't be reimbursed by any other than the three designated medical institutions?

A

The following cases of general outpatient consultation in non-selected medical institutions are eligible for reimbursement under the medical insurance:

1. First aid and rescue. The medical expenses within the scope of the policy incurred by the participant in non-selected medical institutions due to first aid and rescue needs can be reimbursed by the medical insurance in accordance with the provisions of the policy.

2. Referral. Participants can be referred by the selected medical institutions, within 30 days to non-selected medical institutions incurred within the scope of the policy of medical expenses can be reimbursed in accordance with the provisions of the medical insurance.

Q

2. What is the annual outpatient coverage?

A

(a) The policy stipulates that the annual maximum payment limit of the General Outpatient Coordination Fund of the health insurance for active employees is 2.5% of the average annual salary of urban on-the-job workers in the city in the previous year. The annual maximum payment limit for retired employees is increased by 10% on top of that for active employees. Resident medical insurance general outpatient co-ordination fund annual maximum payment limit, for the working employee medical insurance general outpatient co-ordination fund annual maximum payment limit of 80%. 2022 employee or resident medical insurance general outpatient co-ordination fund annual maximum payment limit, according to the date of implementation of the rules to 31 December 2022 the remaining months of the commutation of the implementation of the rules.

(b) According to the 2021 Guangdong Statistical Yearbook published in Foshan City 2020 average annual wages of on-the-job employees, calculated from November 1 to December 31, 2022, the annual maximum payment limit of the general outpatient co-ordination fund of the in-service employees' health insurance is 394 yuan / person (rounded up to the nearest whole number), and the annual maximum payment limit of the general outpatient co-ordination fund of the retired employees' health insurance is 433 yuan / person (rounded up to the nearest whole number). The annual maximum payment limit of the general outpatient co-ordination fund for retired workers' health insurance is 433 yuan/person (rounded up to the nearest whole number), and the annual maximum payment limit of the general outpatient co-ordination fund for residents' health insurance is 315 yuan/person (rounded up to the nearest whole number).

Q

1. In Foshan, can I choose a point across the city?

A

If a participant belongs to a foreign settlement retirement, foreign long-term residence, permanent foreign work, in accordance with the provisions of the medical insurance agency for the record of foreign medical procedures, can be in the place of filing and participation in the place of **** selected no more than three designated health care institutions for medical treatment to enjoy the reimbursement of medical insurance, of which at least one is a primary health care institutions. In principle, the selected health care institutions in the filing place are the designated health care institutions that have realized the direct settlement of basic health insurance network in other places, and the filing and approval of the medical insurance agency will take effect after the filing and approval of the medical insurance agency.

The medical expenses within the policy scope incurred in the medical and health institutions in the filing place will be paid by the integrated fund in accordance with the payment ratio of the same type of treatment in the place of participation, and the cumulative maximum payment limit of the same type of treatment in the place of participation and the filing place will be calculated together.

Q

2. foreign employment in Foshan and pay social security health insurance, can choose a point in Foshan City?

A

In the city of employment and insured employee health insurance participants, in the city health insurance designated medical institutions in the general outpatient clinic to see a doctor before, must be selected to enjoy the city health insurance general outpatient treatment.

Q

3. For outsiders, when can the same province and city, but also fixed point?

A

We recommend consulting the medical insurance department of the insured place, according to the policy regulations of the insured place.