What is the reimbursement ratio of medical insurance outpatient service?

Legal analysis: First, the reimbursement ratio of medical insurance outpatient service for employees:

After the on-the-job employees see a doctor in the outpatient and emergency department of the hospital, the medical expenses of more than 2,000 yuan can be reimbursed, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.

Two, residents' medical insurance outpatient reimbursement ratio:

Outpatient settlement procedure: Insured patients will pay the medical expenses incurred in the outpatient service of designated medical institutions directly by swiping the card at the resident medical insurance settlement counter with the special medical insurance prescription and social security card. In an insurance year, if the total outpatient expenses are below 50 yuan, the medical insurance fund will pay 4 o%, and the expenses above 50 yuan will be borne by individuals.

Three, rural medical insurance outpatient reimbursement ratio:

(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.

(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.

(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.

(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.

(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.

Legal basis: Article 25 of the Social Insurance Law of People's Republic of China (PRC), the state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope: (1) should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (three) shall be borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.