medical insurance has been opened nationwide for medical treatment in different places. Since February 1, 221, 27 provinces, municipalities and autonomous regions across the country have opened a pilot program for inter-provincial settlement of general outpatient fees (excluding chronic outpatient fees). Inter-provincial settlement of outpatient expenses depends on the national settlement system. Therefore, as long as we go through the filing procedures for remote hospitalization before remote medical treatment, the direct settlement service for general outpatient expenses will be opened simultaneously. After that, the expenses incurred by the remote clinic can be settled directly with the medical insurance card, and the insured person does not need to pay in advance. In addition, for employee medical insurance, the proportion of general outpatient payment starts from 5%. In the future, inpatient and outpatient medical care will also be included in the overall account reimbursement, which will really help patients save a lot of real money.
since March p>221, the new national medical insurance drug list has been officially implemented. After consultation with pharmaceutical manufacturers, the price of drugs was reduced by 5.64%, and 119 drugs were newly included in the medical insurance catalogue. In fact, by the end of 22, 12 provinces and cities have become pilot cities, and 27 pilot cities have been added this time. The pilot provinces and cities include: Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, Yunnan, Sichuan, Guizhou, Tibet, Shanxi, Inner Mongolia, Liaoning, Jilin, Heilongjiang, Fujian, Jiangxi, Shandong, Hubei, Guangxi, Hainan, Shaanxi, Qinghai, Ningxia, Sichuan, Guizhou and Tibet, with only some overall planning areas.
1. In 221, there are three new changes in medical insurance reimbursement for medical treatment in different places: the hospitalization threshold is defined. The employees insured by provincial basic medical insurance are hospitalized in designated medical institutions with medical insurance level I, II and III, and the hospitalization threshold is 5 yuan, 65 yuan and 8 yuan respectively. Employees who have been hospitalized for many times in medical institutions at the same level within one year, and the medical expenses for the last hospitalization exceed the Qifubiaozhun, shall be reduced by 2% in turn according to the Qifubiaozhun. The medical institution, the minimum is not lower than 2 yuan.
2. Adjust the reimbursement rate of non-local inpatients. Insured employees who participate in the provincial basic medical insurance shall be hospitalized in the designated medical institutions of Beijing, Tianjin and Beijing after receiving medical treatment in different places in accordance with the relevant provisions of provincial medical insurance. Except for medical institutions in Shanghai, Guangzhou, Shenzhen, Beijing and Tianjin, which are included in the designated mutual recognition scope of provincial medical insurance, the proportion of hospitalization reimbursement for basic medical insurance is reduced by 1 percentage points per payment; The proportion of hospitalization reimbursement in designated medical institutions other than Beijing-Tianjin-Shanghai-Guangzhou-Shenzhen designated first-class and second-class medical insurance or Beijing-Tianjin-Shanghai-Guangzhou-Shenzhen telemedicine insurance will not be reduced.
3. Adjust the reimbursement rate for hospitalization. If the minimum payment standard of provincial basic medical insurance is higher than the hospitalization threshold, the reimbursement rate of the medical insurance pooling fund will be adjusted as follows: for the employees who are hospitalized in designated medical institutions for the first time, the amount paid by the pooling fund is 3, yuan, and the reimbursement rates within the policy range are 91%, 88% and 83%; The overall fund pays 3,-7, yuan, and the reimbursement rates within the policy range are 93%, 9% and 85%; The overall fund pays 7,-2, yuan, and the reimbursement rates within the policy range are 95%, 92% and 87%. In the above-mentioned payment link, the reimbursement ratio of retired employees of medical insurance will be increased by 1 percentage point.
4. Different provinces are different. It is suggested that medical records should be filed according to the different places of insurance. If you want to know whether it is necessary to put on record, you can click on "Public Health" and "Public Inquiry" in the navigation bar below through WeChat official account of the National Medical Insurance Bureau. "Inter-provincial direct settlement and co-ordination area for general outpatient expenses", select the province to be queried, and click the query button to query; Or you can choose to consult your local medical insurance agency. The insured who has handled the inter-provincial direct settlement and filing of medical and hospitalization expenses of basic medical insurance can also open the inter-provincial direct settlement business of general outpatient expenses without filing separately. First of all, you must pay the medical expenses in advance. When leaving the hospital, ask the medical unit for the original invoice, drug list and medical record. Then bring my ID card, medical insurance card, original bill, medication list, medical record and other materials to the local medical management center or the medical insurance reimbursement window of designated medical institutions for reimbursement.