How to reimburse outpatient medical insurance in 2023?

The reimbursement policies for outpatient medical insurance in 2023 are as follows:

1, deductible line: the deductible line for outpatient medical insurance reimbursement is 100 to 200 yuan, and the specific amount varies according to regions and policies.

2. Reimbursement ratio: 60% for employees and 80% for retirees (including unified supplementary medical insurance for retirees).

3. Reimbursement limit: starting from 2023, the maximum payment limit for employee medical insurance clinics will no longer be set, and the reimbursement ratio below 20,000 yuan will remain unchanged; Employees with more than 20,000 yuan will be reimbursed 60%, and retirees will be reimbursed 80% (including unified supplementary medical insurance for retirees). There is no upper limit.

4. Serious illness insurance: After enjoying the basic medical insurance benefits, within one year, the accumulated personal out-of-pocket medical expenses of outpatients and inpatients will not be capped with "second reimbursement" for the part exceeding the minimum Qifubiaozhun.

In 2023, the outpatient medical insurance reimbursement policy cancelled the capping line, which means that the insured can enjoy a higher reimbursement amount when seeking medical treatment in the outpatient department. In practice, the insured should pay attention to the following aspects:

1, deductible line: the deductible line for outpatient medical insurance reimbursement is 100 to 200 yuan, which means that before the medical expenses reach the deductible line, the insured needs to bear the expenses themselves.

2. Reimbursement ratio: 60% for employees and 80% for retirees (including unified supplementary medical insurance for retirees). This means that above the deductible, the insured can get medical insurance reimbursement according to the corresponding proportion.

3. Reimbursement limit: From 2023, the maximum payment limit for employee medical insurance outpatient service will no longer be set, which means that the insured can enjoy a higher reimbursement limit when seeking medical treatment in outpatient service.

4. Serious illness insurance: After enjoying the basic medical insurance benefits, within one year, the accumulated personal out-of-pocket medical expenses of outpatients and inpatients will not be capped with "second reimbursement" for the part exceeding the minimum Qifubiaozhun. This means that for seriously ill patients, the medical insurance reimbursement policy can provide more adequate protection.

In addition to the outpatient medical insurance reimbursement policy mentioned above, the insured should also pay attention to the following aspects:

1. Designated medical insurance institutions: Insured persons need to seek medical treatment in designated medical insurance institutions before they can enjoy the medical insurance reimbursement policy. When choosing a medical institution, we should pay attention to whether it is a designated medical insurance institution.

2. Medical insurance drug list: there are restrictions on drugs and medical treatment items within the scope of medical insurance reimbursement. Insured persons should pay attention to the medical insurance drug list and the diagnosis and treatment project list when seeking medical treatment to ensure that the expenses can be reimbursed.

3. Personal account mutual aid: From 2023, outpatient medical treatment will no longer be paid by medical insurance personal account, but the outpatient mutual aid mechanism will be implemented. This means that the funds in the insured's personal account can be used for the medical expenses of family members.

To sum up, in 2023, the outpatient medical insurance reimbursement policy cancelled the capping line, increased the reimbursement ratio and reimbursement limit, and provided more adequate medical security for the insured. In practice, the insured should pay attention to the deductible, reimbursement ratio, reimbursement limit and serious illness insurance, and pay attention to the selection of designated medical insurance institutions and medical insurance drug lists. In addition, the implementation of personal account mutual aid mechanism also facilitates the medical expenses of family members.

Legal basis:

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

chapter three

basic medical insurance

Article 24

The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.