From June 1, outpatient service can also be reimbursed.
Outpatient treatment beyond 20 yuan can be reimbursed.
Insured persons can enjoy outpatient reimbursement.
In the past, only 3 1 diseases could be reimbursed by outpatient department. From April 1, all diseases within the scope of medical insurance can be reimbursed. In a natural year, the minimum payment standard for general outpatient medical expenses that meet the scope of payment is 20 yuan (beyond 20 yuan, which can be reimbursed).
Seven kinds of outpatient treatments, such as lipoma (including sebaceous cyst) resection, breast tumor resection, tendon sheath cyst removal, cataract surgery (intraocular lens implantation), pterygium resection (stem cell transplantation), cervical polyp and diagnostic curettage, can also be reimbursed.
More than 60% of active employees and 65% of retired employees.
In the designated medical institutions outpatient medical treatment, individuals only need to pay Qifubiaozhun and the individual pays part, and the expenses paid by the overall fund are directly settled by the Municipal Medical Insurance Bureau and the designated medical institutions; In the non-choice of outpatient treatment, do not enjoy outpatient co-ordination treatment.
The reimbursement rate of medical expenses that exceed the deductible line and meet the payment scope is: 60% for employees and 65% for retirees.
Among them, the general inspection fee is paid 80% each time, and the maximum monthly payment limit of the urban workers' medical insurance outpatient co-ordination fund is 150 yuan (excluding outpatient surgery to treat diseases).
In other words, the insured employees can enjoy the outpatient reimbursement treatment when they go to the designated outpatient clinic with the medical insurance card and medical insurance book, and they can be reimbursed if they exceed 20 yuan. The maximum monthly medical insurance payment is 150 yuan, including the medical expenses and examination fees.
This newspaper1October 9th, 65438 (Reporter Qin Xin correspondent Zhang Xiaojun) In order to expand the coverage of urban residents' basic medical insurance system and effectively reduce the burden of medical expenses of insured residents' general outpatient clinics, on the 9th, the reporter learned from Weifang Human Resources and Social Security Bureau that since 20 13, Weifang urban residents' basic medical insurance general outpatient clinics have been co-ordinated, and those who participate in the basic medical insurance for urban residents can also be reimbursed for seeing a doctor in general outpatient clinics.
The reporter learned on the 9th that starting from 20 13, the general outpatient service of Weifang's urban residents' basic medical insurance will be co-ordinated, and all the people participating in the basic medical insurance for urban residents will be included in the co-ordination scope of the general outpatient service of 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 now realized the contracted medical service model. Insured persons can choose one of the designated medical institutions for general outpatient clinics announced by the Municipal People's Social Security Bureau as their contracted medical institutions according to the principle of convenience nearby. All kinds of students in the school implement collective contract, that is, taking the school as a unit, choose a designated medical institution as the contracted medical institution for all 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 outpatient 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 treatment, the insured person will only settle the expenses that should be borne by the individual, and the rest will be settled by social insurance agencies and designated medical institutions. Outpatient medical expenses incurred without online medical treatment will not be reimbursed.
The staff of Weifang Human Resources and Social Security Bureau told the reporter that if the insured person has been treated continuously for no more than 5 days, it can be treated as a medical treatment and only bear the standard of one-time deductible.
Ordinary outpatient clinics can also be reimbursed, which makes many residents very happy. "I didn't expect to go to a community hospital to make an infusion bag or something, and I can still reimburse it. It is really convenient and saves money. "
1 Interpretation: General outpatient medical expenses can be reimbursed by 50% within the policy scope.
In the past, people had to pay for outpatient services themselves. Now, for the medical expenses incurred by the insured that meet the scope of payment by the general outpatient co-ordination fund, the individual pays the 20 yuan first, and the excess is reimbursed by the general outpatient co-ordination fund by 50%. In a medical year, the maximum payment limit of the general outpatient co-ordination fund is 300 yuan, and the insured does not enjoy outpatient co-ordination treatment during hospitalization.
Insured personnel 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 selected outpatient medical institutions from September 1 day to February 20th every year, clarifying the rights and obligations of both parties, and the service agreement will take effect from June 1 day of the following year.
The collective signing time of all kinds of students in the school is from August 1 day to February 20 1 day every year. The school will sign a service agreement with the selected outpatient designated medical institutions, and the service agreement will take effect from the month of signing.
After the newborn insurance payment, 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 on 20 13, in order to benefit the insured earlier, the signing time of 20 13 in the medical year was advanced to March 3 1 3 on 20 13, and the insured could sign a contract with a designated outpatient medical institution, and the service agreement would take effect from the next month.
Interpretation 2: A valid certificate is required to change the signing information.
The service agreement shall not be changed within one medical year after it is signed (except for students entering higher education or being suspended or disqualified from 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.
According to the staff, if the insured (excluding students in school) really need to change the contracted medical institution in the next medical year, they can sign a service agreement with the re-selected outpatient designated medical institution during the signing period, and change the signing information with valid documents such as ID card and social security card and service agreement. The new service agreement came into effect on June 65438+ 10/day of the following year.
Students who collectively change the contracted medical institutions can cancel the contract with the original contracted medical institutions from August 1 to August 3 1 every year, and then sign a service agreement with the newly selected outpatient designated medical institutions, and change the contract information with the social insurance agency by virtue of the service agreement. The school is responsible for informing the insured students of the changed signing information. The new service agreement will take effect on September 1 day 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 school can change the contracted medical institution from the next month and enjoy the relevant outpatient medical treatment, and the original service agreement will be automatically terminated.
Source: Qilu Evening News