From June 5438+1 October1day, 2023, the basic medical insurance policy for employees in Zibo ushered in adjustment, further improving the basic medical insurance system for mutual assistance and sharing employees, optimizing the use structure of medical insurance funds, improving the use efficiency of medical insurance funds, better solving the outpatient enrollment problem of insured personnel and effectively reducing their daily medical expenses. Recently, the municipal government issued the "Detailed Rules for the Implementation of the Economic Security Mechanism of the Basic Medical Insurance Outpatient in Zibo", and made the following adjustments to the general outpatient treatment of employees:

From June 5438 +2023 10, in a natural year, the minimum payment standards for general outpatient medical care for employees are 50 yuan, 500 yuan and 700 yuan respectively, and the maximum payment limit for general outpatient medical care is 3,000 yuan; General outpatient policy Qifubiaozhun above and within the maximum payment limit of medical expenses, respectively, according to the proportion of 60%, 60%, 50%. From June 5438+ 10, 2024, the maximum payment limit for general outpatient service was raised to 4,000 yuan, and the proportion of retirees increased by 5 percentage points.

Long-term residents in different places seek medical treatment in outpatient clinics, and the reimbursement policy of medical institutions at the same level in our city is implemented. Temporary outpatient medical staff in other co-ordination areas for outpatient treatment, outpatient medical expenses in line with the provisions, the individual pays 10%, the implementation of the treatment of medical institutions at the same level in our city.

The general outpatient service of employee medical insurance shall co-ordinate the implementation of the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and payment standards.

The employee medical insurance general outpatient co-ordination fund does not cover the following payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Going abroad for medical treatment;

(5) General outpatient medical expenses incurred during hospitalization;

(six) other relevant provisions shall not pay the cost of the project.