Recently, many citizens have consulted the reimbursement policy for general outpatient service of medical insurance for employees. To this end, the Municipal Medical Insurance Bureau specifically answered: First, it is necessary to find out what the three terms "minimum payment standard", "maximum payment limit" and "payment ratio" mean.

Qifubiaozhun:

Also known as "deductible" and "threshold fee", it refers to the expenses that the insured person needs to pay before enjoying the reimbursement of medical expenses. Outpatient deductible is calculated on an annual cumulative basis, and it is not necessary to exceed deductible every time before reimbursement can be made.

Maximum payment limit:

Also known as the "capping line", it refers to the upper limit of medical expenses paid by the medical insurance fund to the insured in a year. The medical insurance fund will not pay the medical expenses exceeding the limit.

Payment ratio:

Also known as "reimbursement ratio", it refers to the proportion that the medical expenses of the insured are reimbursed by the medical insurance fund above the Qifubiaozhun and below the maximum payment limit.

The provisions on the payment of general outpatient (emergency) medical expenses by employees' medical insurance participants are as follows:

First, the general outpatient expenses of employees in the city within the scope of the policy of coordinating designated medical institutions, the annual minimum payment standard of medical insurance fund is 1 000 yuan, and the payment limit is 4000 yuan. Community health service centers (township hospitals), cities (counties) and other medical institutions and provincial medical institutions pay 60%, 55% and 50% respectively;

The minimum annual payment standard for retirees is 800 yuan, and the payment limit is 5,000 yuan. The payment ratio of medical institutions at all levels increased by 5 percentage points on the basis of on-the-job employees.

Two, the insured during the hospitalization of general outpatient expenses, general outpatient co-ordination fund will not be paid, not included in the cumulative scope of general outpatient expenses.

Three, general outpatient medical expenses are not included in the scope of payment of serious illness insurance and medical assistance fund. The Municipal Medical Insurance Bureau reminds the general public that after seeing a doctor in the hospital, you must remember to bring your social security card or medical insurance electronic certificate to the medical insurance settlement window before you can enter the accumulation!