The annual maximum payment limit of outpatient co-ordination for on-the-job employees is 1.800 yuan, and the payment of outpatient co-ordination benefits is appropriately tilted to retirees. Insured employees can buy medicines at designated retail pharmacies in outpatient co-ordination. On June 65, 438+04, Shanxi Medical Insurance Bureau released a message. Our bureau, together with the Provincial Department of Finance and the Provincial Health and Health Commission, jointly issued the Measures for the Overall Management of General Outpatient Service of Employees' Basic Medical Insurance (J.H.F. [2022] 1 2), and since June 5438+1October1day, 2023, a unified overall system of general outpatient service of employees' basic medical insurance has been fully implemented in the province.

According to the latest employee medical insurance outpatient co-ordination system, the medical expenses of the insured who participate in Shanxi employee medical insurance and have personal medical insurance accounts for treating common diseases and frequently-occurring diseases in the general outpatient department of designated medical institutions, as well as the medical expenses of purchasing drugs outside the outpatient prescription of designated retail pharmacies, are paid by the employee medical insurance co-ordination fund in accordance with the regulations.

In a natural year, the maximum annual payment limit for outpatient co-ordination of on-the-job employees is 1800 yuan. Insured employees (including retirees) go to the designated medical institutions for treatment according to the three kinds of charging prices and below, the second kind of charging prices and the first kind of charging prices, and the outpatient co-ordination Qifubiaozhun is 30 yuan/time, 50 yuan/time and 80 yuan/time respectively. The proportion of outpatient expenses incurred by employees in designated medical institutions with class I, class II, class III and below fees is 50%, 55% and 60% respectively. Outpatient overall treatment payment is appropriately tilted to retirees. The annual maximum payment limit is higher than that of 200 yuan, and the proportion of medical institutions at the same level is 5 percentage points higher than that of employees. Insured workers can't meet the demand for drugs in the outpatient department of designated medical institutions, and can buy drugs in the designated retail pharmacies with the prescription of designated medical institutions. In accordance with the provisions of the drug costs can also be reimbursed in the outpatient department as a whole, Qifubiaozhun and fund payment ratio according to the designated medical institutions for prescription level.

It is understood that the implementation of the employee medical insurance outpatient co-ordination system will enhance the economic security function of the employee medical insurance outpatient service in our province, improve the outpatient security mechanism for common and frequently-occurring diseases of insured employees, further improve the outpatient security treatment level of insured employees in our province, and effectively reduce the burden of medical expenses. Shanxi Daily New Media Reporter Li Qianqian