The payment scope of the urban and rural residents' medical insurance outpatient co-ordination fund is: Class A and Class B drugs in the residents' medical insurance drug list, as well as the scope of medical treatment projects and medical service facilities that allow payment of fees. Outpatient medical expenses beyond the scope of payment, outpatient medical expenses incurred by other medical institutions other than designated medical institutions for urban and rural residents' outpatient co-ordination shall not be paid by the outpatient co-ordination fund.
Zhengzhou medical insurance outpatient reimbursement policy is as follows:
1, personal medical insurance coverage adjustment:
(1) The coverage of urban and rural residents' medical insurance system includes the existing urban residents' medical insurance and all the participants of the new rural cooperative medical system, that is, it covers all urban and rural residents except the employees' basic medical insurance;
(two) migrant workers and flexible employees to participate in the basic medical insurance for employees in accordance with the law, there are difficulties can be in accordance with local regulations to participate in medical insurance for urban and rural residents.
2. How to raise funds for individual medical insurance:
(1) Adhere to multi-channel financing, continue to implement the financing method of combining individual contributions with government subsidies, and encourage collectives, units or other social and economic organizations to give support or funding;
(2) Reasonably divide the financing responsibilities of the government and individuals, and appropriately increase the proportion of individual contributions while raising the government subsidy standard.
3, individual medical insurance financing standards:
(1) All localities should consider the needs of urban and rural residents for medical insurance and serious illness insurance as a whole, and reasonably determine the unified financing standards for urban and rural areas according to the principle of fund balance;
(2) In areas where there is a big gap between the existing medical insurance for urban residents and the individual payment standard of the new rural cooperative medical system, the differential payment method can be adopted, and it will take 2 to 3 years to gradually transition;
(three) after the integration, the actual per capita financing and individual contributions shall not be lower than the existing level.
4, personal medical insurance benefits:
(1) Follow the principle of moderate security and balance of payments, balance the interests of urban and rural security, and gradually unify the scope of security and payment standards;
(2) the urban and rural residents' medical insurance fund is mainly used to pay the medical expenses of the insured for hospitalization and outpatient service;
(3) Stabilize the level of hospitalization insurance, and keep the proportion of hospitalization expenses around 75% within the policy scope;
(4) to further improve the outpatient co-ordination and gradually improve the level of outpatient support;
(5) Gradually narrow the gap between the payment ratio and the actual payment ratio within the scope of the policy.
5, the implementation of new personal medical insurance:
(1) All provinces should make plans and arrangements for the integration of medical insurance for urban and rural residents before the end of June, define the timetable and road map, and ensure that all policies and measures are put in place;
(2) Each overall planning area shall issue specific implementation plans before the end of 12.
To sum up, Zhengzhou medical insurance reimbursement is divided into three categories. Among them, citizens who apply for reimbursement of hospitalization in different places need to prepare hospitalization settlement invoice (seal), detailed list of hospitalization expenses (seal), medical insurance card and discharge record (seal) and other materials, and go to the local medical insurance bureau for reimbursement five working days later.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 23
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.