Shandong outpatient reimbursement policy 2023 latest

The specific standards for outpatient reimbursement in Shandong in 2023 are as follows:

1. The reimbursement rate of employee health insurance is divided according to the actual medical expenses incurred by the insured, usually the minimum reimbursement rate for hospitalization is 85%, and the maximum reimbursement rate is 95%; the reimbursement rate of urban and rural residents' health insurance is divided according to the level of the hospital, which ranges between 50% and 80%. As different regions have different economic levels, the reimbursement rate may also be slightly different in medical reimbursement."

2, medical insurance card reimbursement is generally in accordance with the proportion of reimbursement, generally reimbursement of 60%-70% . In a billing year, incurred in line with the scope of reimbursement of medical expenses of less than 100,000 yuan, the starting standard for tertiary hospitals is 659 yuan, reimbursement rate of 50 percent of the upper limit of 2,000 yuan, the starting standard for hospitalization in secondary hospitals is 300 yuan, reimbursement rate of 55 percent, and the first level of hospitals do not have a starting standard, reimbursement rate of 60 percent.

Medicare reimbursement rates are as follows:

Medicare reimbursement rates are determined according to local policies and regulations, and may vary in different regions. Generally speaking, the reimbursement ratio of medical insurance includes two aspects:

1. Basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion of the medical insurance fund payment, generally ranging from 70% to 80%;

2. Individual out-of-pocket payment ratio: the individual out-of-pocket payment ratio refers to the proportion of medical expenses that the individual needs to bear, generally ranging from 20% to 30%.

Medical insurance reimbursement process:

1, confirm the scope of reimbursement: in the process of treatment, you need to confirm that their own treatment items belong to the scope of reimbursement of medical insurance;

2, collection of reimbursement materials: collection of the relevant records of treatment, drug receipts, medical cost lists and other related materials;

3, the social security department to handle the reimbursement: submit the relevant materials to the local social security department to handle the reimbursement.

4. Waiting for the audit: the social security department will carry out relevant audits and comparisons to confirm the reimbursement rate and reimbursement amount; receiving the reimbursement payment: after the audit is approved, you can receive the reimbursement payment of the medical insurance at the designated bank.

In summary, the hospitalization reimbursement rate of Chengdu Municipal Health Insurance is generally 50% to 95%. The reimbursement rate of each area of health insurance is different, urban and rural residents living in a long time in a different place, men aged 60 years old, women aged 55 years old urban and rural residents and urban and rural residents working in a different place, students and children living with them, for the record of registration for medical treatment in a different place, in the registration record for the hospitalization of hospitalization in a place of 400 yuan for a hospital, 800 yuan for a second level, 2000 yuan for a third level, reimbursement rate for the implementation of local The reimbursement rate is the same as the local reimbursement rate for designated hospitals.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical services and facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.