Latest regulations on outpatient reimbursement of Fujian medical insurance in 2023

The latest regulations on outpatient reimbursement of Fujian medical insurance in 2023 are as follows:

1, 60% reimbursement for visits to village clinics and village center clinics, prescription drug cost limit for each visit 10 yuan, and prescription drug cost limit for temporary rehydration for doctors in health centers in 50 yuan;

2. The reimbursement rate of town hospitals is 60%, and the deductible line is 200 yuan; The reimbursement ratio is: 90%, and the deductible line is 400 yuan;

3. The reimbursement rate of secondary hospitals is 40%, and the deductible line is 500 yuan; The reimbursement ratio is: 85%, and the deductible line is 700 yuan;

4. The reimbursement rate of tertiary hospitals is: 30%, and the deductible line is 700 yuan; The reimbursement rate is: 80%, and the deductible is 1000 yuan;

5. The reimbursement rate of hospitals outside the province is: 20%, and the deductible is 2000 yuan; The reimbursement rate is: 60%, and the deductible is 3,000 yuan.

Fujian medical insurance outpatient reimbursement materials are:

1. Original and photocopy of my social security card or ID card (newborn household register);

2. Outpatient medical records and photocopies of designated medical institutions, general list of medical expenses, effective charging documents, short-term doctor's orders of residents and discharge summary. (The above materials need to be stamped with the official seal of the hospital);

3, the insured shall provide the "Fuzhou basic medical insurance insured inpatient medical identity checklist";

4. My settlement account in China Agricultural Bank;

5. Reimbursement under special circumstances.

In 2023, the matters needing attention for outpatient reimbursement of Fujian medical insurance are as follows:

1, medical insurance outpatient reimbursement is limited to the general outpatient medical expenses incurred by the insured in designated medical institutions, excluding emergency, outpatient serious illness, hospitalization, physical examination and other medical expenses;

2. Outpatients need to reach the deductible line to be reimbursed, that is, medical expenses need to reach the deductible line to be reimbursed. The specific deductible standards are: 800 yuan, an incumbent, and 600 yuan, a retiree, with a maximum payment of 20,000 yuan;

3 "two diseases" outpatient reimbursement, need to hold the relevant medical records and inspection reports, the medical insurance agency for examination and confirmation before reimbursement.

4. Employees and retirees can reimburse general outpatient medical expenses incurred in designated medical institutions, but the reimbursement ratio is different, as follows: the reimbursement ratio of employees is 60%, and that of retirees is 70%;

To sum up, the above are the matters needing attention for outpatient reimbursement of Fujian medical insurance in 2023, and you can consult the local social security department for details.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) 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.