Total outpatient visits per month 15 or more; General outpatient visits have accumulated more than 30 times for 3 consecutive months; The monthly medical expenses of general outpatient service accumulated more than 6000 yuan; In the same medical insurance year, the total medical expenses of general outpatient clinics exceeded 20,000 yuan; When the personal account is used up and enters the "self-funded period", it is necessary to use the basic medical pooling fund and the local supplementary medical insurance fund; There is a report in violation of the provisions of the Measures.
The scope of use of medical insurance cards mainly includes the following three aspects:
1, used to buy medicine: when the insured buys medicine at the designated pharmacy, they can pay with the medical insurance card.
2. Used for reimbursement: If you go to the hospital for medical treatment, whether it is outpatient or inpatient, you can use the medical insurance card for reimbursement if it reaches the medical insurance deductible line and is within the scope of medical insurance reimbursement.
3. Medical expenses: When the participants are sick, they can register with the designated hospital with the medical insurance card and medical insurance manual. The main process is as follows: holding the medical insurance manual and medical insurance card-registering with the hospital medical insurance office-reviewing the card-paying the hospitalization deposit-hospitalization-the patient agrees to the self-funded project and signs it-cash or medical insurance card.