1. Outpatient reimbursement ratio: the medical insurance fund pays 50% of the outpatient medical expenses incurred by the insured, and the cumulative maximum payment limit in a medical insurance settlement year is 1500 yuan;
2. Hospitalization reimbursement ratio: the reimbursement ratio of hospitalization medical expenses incurred by the insured is 75% in tertiary medical institutions, 80% in secondary medical institutions and 85% in primary medical institutions;
3. Outpatient care for chronic diseases and special diseases: provide outpatient care for five kinds of chronic diseases and special diseases, such as hypertension, diabetes, malignant tumor outpatient radiotherapy and chemotherapy, uremia dialysis and organ transplantation anti-rejection treatment, which are in great demand and heavy cost burden. The medical expenses for outpatient treatment of related diseases are included in the scope of medical insurance fund according to regulations, and the annual maximum payment limit is 300 yuan;
4. Accidental injury reimbursement: the hospitalization medical expenses caused by sudden injury of the insured shall be paid according to the provisions of the fund.
Yangzhou medical insurance outpatient reimbursement process is as follows:
1, you need to bring relevant information to the relevant departments of the local social security center to apply for reimbursement;
2. Upon examination, if the information is complete and meets the requirements, it can be handled immediately;
3. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the out-of-pocket part of hospitalization expenses in this social security year, then deduct the out-of-pocket part of outpatient quota in this social security year (residents' medical insurance has no outpatient quota), and then reimburse according to the facts.
Yangzhou medical insurance outpatient reimbursement needs the following materials:
1, original ID card or social security card;
2, the original certificate of disease diagnosis issued by the designated medical institutions;
3, outpatient medical records, inspection, test results report and other original medical information;
4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;
5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;
6. If others handle it on their behalf, the original ID card of the handler shall be provided.
To sum up, the above are the materials needed for reimbursement of Yangzhou medical insurance outpatient service, hoping to help.
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;
(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.