one
Policy basis
According to the spirit of the Hunan Provincial People's Government's Implementation Opinions of the General Office of Hunan Provincial People's Government on Establishing and Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients (Xiang Zhengban [2022]12) and the Hunan Provincial Medical Security Bureau's Overall Planning Method for General Outpatients' Basic Medical Insurance for Urban Employees in Changsha, Zhuzhou and Xiangtan (Trial), the overall planning policy for urban employees' basic medical insurance in Changsha, Zhuzhou and Xiangtan is 65432.
two
Applicable people
Medical insurance for employees (including flexible employees) in Changsha (Tianxin District, Yuhua District, Kaifu District, Furong District, Yuelu District, High-tech Zone and Wangcheng District), Ningxiang City, Zhuzhou City and Xiangtan City.
three
Payment invoice
Bring electronic medical insurance card, ID card and social security card.
four
clearing form
Medical expenses are settled directly in the hospital, and the insured only needs to pay part of the expenses paid by the individual; The expenses paid by the outpatient co-ordination fund shall be settled by the hospital and the medical insurance bureau according to the agreement.
five
Reimbursement standards and procedures
Our hospital is a grass-roots hospital, and there is no Qifubiaozhun. In a natural year, the maximum reimbursement amount for on-the-job employees is 1500 yuan/year, and the maximum reimbursement amount for retired employees is 2000 yuan/year. 70% reimbursement.
1. reimbursement scope
1, the outpatient and emergency medical expenses incurred by the insured in the designated medical institutions for outpatient co-ordination are included in the scope of reimbursement for outpatient co-ordination.
2. The scope of reimbursement is consistent with the basic medical insurance, that is, the list of basic medical insurance drugs, the list of medical services and the list of medical consumables stipulated by the state, province and city. Beyond the scope of reimbursement of basic medical insurance, it will not be reimbursed.
3. Employees' medical insurance insured persons do not enjoy outpatient co-ordination reimbursement during hospitalization, and can enjoy reimbursement the next day after discharge.
4. Patients who enjoy specialist clinics and fertility clinics still follow the original implementation path.
5, outpatient nucleic acid testing costs, temporarily not included in the general outpatient co-ordination policy payment scope.
2. Medical insurance will not be reimbursed.
1, which shall be paid from the industrial injury insurance fund;
2. Should be borne by a third party;
3, should be borne by public health;
4. Go abroad for medical treatment;
5. Fitness, health care consumption, physical examination, cosmetic surgery, etc.
6, the provisions of the state medical insurance fund will not pay other expenses;
7. Including the expenses below the deductible line, above the capping line and outside the medical insurance catalogue;
8. Beyond the medical insurance catalogue: drug catalogue, diagnosis and treatment project catalogue and service facilities catalogue.
3. Overall reimbursement process of outpatient department
Registration: You can make an appointment for registration through the official WeChat account of the hospital, the automatic numbering machine in the hospital hall and the artificial window of the hospital.
See a doctor: go to the outpatient clinic for examination and treatment according to the condition, and actively inform the doctor of the types of medical insurance.
Settlement: Don't pay by WeChat. Please bring one of the electronic medical insurance card, ID card and social security card to the manual charge window in the outpatient hall for reimbursement.
Telephone numbers of all departments in our center:
_ 884 17576 (Hospital Office)
_ 884 1757 1 (vaccination)
_ 854274 18 (Obstetrics and Gynecology Clinic)
_ 88 127 120 (Ministry of Maternal and Child Health)
_ 852605 17 (general inpatient department)
_ 17307424547_ (Chronic Diseases Department)
_ _ 1536789 125 _ (child health care)
_ 17375742647(TCM & amp； Female rehabilitation)