In a natural year, the expenses incurred in the general outpatient service of designated hospitals shall be paid by the medical insurance pooling account in accordance with the prescribed proportion within the maximum payment limit.

General outpatient service refers to the general outpatient medical expenses (excluding prenatal examination expenses) shared by the basic medical insurance fund and individuals, which are in line with the provisions of the basic medical insurance in our city and are included in the payment scope of the basic medical insurance fund. Its treatment is divided into: co-ordination of employee medical insurance outpatient service, use of special examination and treatment items in employee medical insurance outpatient service (hereinafter referred to as special examination and treatment in outpatient service) and co-ordination of expenses of TCM diseases in employee medical insurance outpatient service (hereinafter referred to as TCM diseases in outpatient service). The basic medical insurance for urban workers in Xi is subsidized by outpatient medical fees, and the medical insurance for employees is specially diagnosed and treated, and the treatment of outpatient Chinese medicine diseases remains unchanged.

Second, Xi employee medical insurance outpatient reimbursement policy

The settlement method of general outpatient service is similar to the settlement of hospitalization expenses. After seeing a doctor or buying medicine in the outpatient department of the hospital, as long as the expenses incurred are within the scope of reimbursement, the hospital will directly and automatically settle the account with electronic certificate, social security card or resident ID card according to the prescribed payment ratio, and there is no need for individuals to reimburse by ticket.

Reimbursement method

When the insured workers enjoy hospitalization, they do not enjoy general outpatient treatment. Outpatient co-ordination and outpatient chronic diseases and special diseases, special drugs, outpatient special examination and special treatment overlap, first use outpatient chronic diseases and special diseases, special drugs, outpatient special examination and special treatment, and may not be repeated.