Legal basis: Measures for Overall Planning of General Outpatient Service of Jinan Residents' Basic Medical Insurance
Article 4 The municipal administrative department of medical security is in charge of the overall work of the general outpatient service of residents' basic medical insurance in our city, and the medical insurance agency (hereinafter referred to as the medical insurance agency) is specifically responsible for the fund raising, management, treatment review and payment of the general outpatient service.
Article 5 Class A drugs in the National Catalogue of Essential Drugs and the National Catalogue of Medicines for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance shall be included in the overall payment scope of general outpatient service. General medical expenses and basic medical items (see attached table) are included in the overall payment scope of general outpatient service according to regulations.
Sixth residents' basic medical insurance general outpatient co-ordination fund financing standard is 60 yuan per person per year. Funds are charged from the residents' basic medical insurance fund and accounted for separately, and the insured person does not pay.
Article 7 In a medical year, the medical expenses incurred by the insured in the general outpatient service and the expenses paid by the general outpatient service pooling fund (excluding the personal burden) are calculated cumulatively. The maximum payment limit for college students is 500 yuan, and the maximum payment limit for children and adults is 400 yuan.
Eighth residents' basic medical insurance for general outpatient treatment enjoys the same treatment as residents' basic medical insurance. There is no qifubiaozhun for the overall treatment of general outpatient department. The general outpatient medical expenses incurred by the insured in a medical year are borne by the general outpatient co-ordination fund for college students, 35% by individuals, 50% by the general outpatient co-ordination fund for other insured persons and 50% by individuals.