What is the reimbursement ratio of Beijing medical insurance outpatient service?

The proportion of reimbursement for outpatient medical insurance in Beijing is that the general outpatient emergency expenses incurred in a natural year exceed 2,000 yuan, 50% of which are paid by some large medical mutual funds of more than 2,000 yuan, and 50% are paid by individuals. The retirees have accumulated more than 1.300 yuan, and the part exceeding 1.300 yuan is covered by the large-scale medical mutual aid fund over 70 years old, with 70% paid by individuals, 30% paid by individuals, 80% paid by the large-scale medical mutual aid fund over 70 years old and 20% paid by individuals. The maximum payment limit in a natural year is 20000 yuan.

Payment process after medical insurance is broken:

1. If the insured fails to pay the medical insurance premium in full and on time as required, they will stop enjoying the medical insurance benefits from the month when they have never paid it in full and on time. If the payment is continued after the interruption, it must be based on the average salary of local employees in the previous year to make up all the arrears during the interruption.

2 overdue time is included in the continuous payment time, but you can't enjoy the payment treatment of the overall fund during the overdue period.

3, the insured to suspend the enjoyment of medical insurance benefits within 60 days (including 60 days) to pay medical insurance premiums, from the next month to enjoy the benefits of pooling funds to pay.

4. If the medical insurance benefits are suspended for more than 60 days to 180 days (including 180 days) to pay back the medical insurance, it will be calculated from the payment month and enjoy the treatment paid by the overall fund after 3 months.

5. If the medical insurance benefits are suspended for more than 180 days and the medical insurance premium is paid back, it will be calculated from the month of payment and enjoy the treatment paid by the overall fund after 6 months.

6. If the payment is not made after the interruption, it shall be deemed as re-participation in medical insurance, and the payment time before the interruption shall not be included in the continuous payment time.

To sum up, the reimbursement ratio is the same as hospitalization. The settlement period of outpatient special diseases is 360 days.

Legal basis:

People's Republic of China (PRC) social insurance law

second

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society according to law in cases of old age, illness, industrial injury, unemployment and maternity.