In the past, only 31 diseases could be reimbursed for outpatient service. From April 1st, all diseases covered by medical insurance can be reimbursed. For the general outpatient medical expenses that meet the scope of payment within a natural year, the minimum payment standard of the monthly overall fund is 2 yuan (if it exceeds 2 yuan, it can be reimbursed).

from January 1st, outpatient visits can also be reimbursed.

outpatient visits exceeding 2 yuan can be reimbursed

insured persons can enjoy outpatient reimbursement.

In the past, only 31 diseases could be reimbursed for outpatient service. From April 1st, all diseases covered by medical insurance can be reimbursed. For the general outpatient medical expenses that meet the scope of payment within a natural year, the minimum payment standard of the monthly overall fund is 2 yuan (if it exceeds 2 yuan, it can be reimbursed).

Seven outpatient treatments, such as lipoma (including sebaceous cyst) excision, breast tumor excision, tendon sheath cyst stripping, cataract surgery (intraocular lens implantation), pterygium excision (stem cell transplantation), cervical polyp and diagnostic curettage, can also enjoy outpatient reimbursement.

If the part of employees exceeds 6%, the retired employees report 65%

When seeking medical treatment in the outpatient department of designated medical institutions, individuals only need to pay the Qifubiaozhun and the individual pays part, and the expenses paid by the overall fund will be directly settled by the Municipal Medical Insurance Bureau and the designated medical institutions; In the non-selected outpatient treatment, do not enjoy the overall treatment of outpatient service.

The reimbursement rate of medical expenses that exceed the threshold and meet the scope of payment is: 6% for employees and 65% for retirees.

Among them, the proportion of general consultation fee paid each time is 8%, and the maximum monthly payment limit of urban workers' medical insurance outpatient co-ordination fund is 15 yuan (excluding outpatient surgical treatment diseases).

In other words, the insured employees can enjoy the outpatient reimbursement treatment when they go to the designated outpatient clinic with their medical insurance cards and medical insurance books, and they can be reimbursed if they exceed 2 yuan, and the maximum monthly medical insurance payment is 15 yuan, which includes medicine fees and examination fees.

The newspaper reported on January 9th (reporter Qin Xin correspondent Zhang Xiaojun) that in order to expand the coverage of the basic medical insurance system for urban residents and effectively reduce the burden of medical expenses for general outpatient clinics of insured residents. On the 9th, the reporter learned from Weifang Human Resources and Social Security Bureau that since 213, the general outpatient service of basic medical insurance for urban residents in Weifang has been co-ordinated, and those who participate in basic medical insurance for urban residents can also be reimbursed for seeing a doctor in the general outpatient service, and 5% of medical expenses can be reimbursed within the policy scope.

on the 9th, the reporter learned that since 213, the general outpatient service of Weifang's basic medical insurance for urban residents has been co-ordinated, and all the people who participated in the basic medical insurance for urban residents have been included in the coverage of the general outpatient service co-ordination of basic medical insurance for urban residents (hereinafter referred to as "general outpatient service co-ordination").

It is understood that the general outpatient service of basic medical insurance for urban residents in Weifang has realized the contracted medical service mode, and the insured can choose one as their contracted medical institution within the designated medical institutions of the general outpatient service announced by the Municipal People's Social Security Bureau according to the principle of convenience nearby. All kinds of students in school implement the collective signing method, that is, taking the school as a unit, uniformly choose a designated medical institution as the signing medical institution for all the insured students in the school. Those who fail to go through the signing formalities according to the regulations do not enjoy the general outpatient medical treatment.

The reporter learned that at present, all general out-patient clinics implement online settlement. When the insured person goes to the outpatient clinic for medical treatment, he should hold his ID card, social security card and other valid documents to the contracted medical institution for online medical treatment. After the end of treatment, the insured person only settles the expenses that should be borne by the individual, and the rest is settled by the social insurance agency and the designated medical institution. Outpatient medical expenses incurred without online medical treatment will not be reimbursed.

The staff of Weifang Municipal Bureau of Human Resources and Social Security told the reporter that if the insured person's continuous treatment does not exceed 5 days, it can be treated as a medical treatment, and only pay the standard of one-time deductible.

Many residents are very happy that the general outpatient service can also be reimbursed. "I didn't expect to be reimbursed when I went to the community hospital to hang a bottle or something in the future. It's really convenient and economical."

Interpretation 1: 5% can be reimbursed within the scope of general outpatient medical expenses policy

In the past, people had to pay their own money for outpatient visits. Now, the medical expenses incurred by the insured who meet the scope of payment by the general outpatient pooling fund are paid by the individual first, and the excess is reimbursed by the general outpatient pooling fund for 5%. In a medical year, the maximum payment limit of the general outpatient co-ordination fund is 3 yuan, and the insured does not enjoy outpatient co-ordination treatment during hospitalization.

The insured shall sign the Agreement on Overall Medical Services for General Outpatients of Basic Medical Insurance for Urban Residents in Weifang (hereinafter referred to as the Service Agreement) with the designated outpatient medical institutions from September 1st to December 2th every year, so as to clarify the rights and obligations of both parties. The Service Agreement shall take effect on January 1st of the following year.

The collective signing time for all kinds of students in school is from August 1st to December 2th every year, and the school will sign a service agreement with the designated outpatient medical institutions, and the service agreement will take effect from the month after signing.

After the newborn is insured and paid, its legal guardian shall sign a service agreement with the designated outpatient medical institution in time.

The staff told the reporter that since the policy was implemented in 213, in order to benefit the insured earlier, the signing date of the medical year in 213 was advanced. Before March 31, 213, the insured can sign contracts with designated outpatient medical institutions, and the service agreement will take effect from the month after signing.

Interpretation 2: A valid certificate is required to change the signing information

It cannot be changed within one medical year after the signing of the service agreement (except that students are suspended or disqualified for signing a medical institution). If the insured does not change the contracted medical institution in the next medical year, the original service agreement will remain valid.

the staff introduced that if the insured (excluding students) really need to change the contracted medical institution in the next medical year, they can sign a service agreement with the re-selected designated outpatient medical institution during the contract signing period, and bring valid certificates and service agreements such as ID cards and social security cards to their social insurance agencies to change the contracted information. The new service agreement will take effect on January 1st of the following year.

if the students in school collectively change the contracted medical institutions, their school can cancel the contract with the original contracted medical institutions from August 1 to 31 every year, and then sign a service agreement with the newly selected designated outpatient medical institutions, with which they can go to their social insurance agencies to change the contract information. The school is responsible for notifying the insured students of the school of the changed signing information. The new service agreement will take effect on September 1st of that year.

It is also known that if the identity of the insured person is changed from a minor resident to a student, the contracted medical institution can be changed by the school, and the relevant outpatient medical treatment will be enjoyed from the next month after the change, and the original service agreement will be automatically terminated.

Source: Qilu Evening News

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