Policy of outpatient reimbursement of medical insurance in Jilin Province

Reimbursement ratio. Proportion of medical insurance reimbursement for on-the-job employees:.

1. After the emergency treatment in the hospital, the medical expenses above 1800 yuan can be reimbursed, and the reimbursement rate is 50%;

2. If it is a retiree under 70 years old,1.The expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%;

3. For retirees over 70 years old,1.80% of the expenses above 300 yuan can be reimbursed. Note: No matter what kind of people, the maximum medical expenses for outpatient and emergency treatment is 20,000 yuan. If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time in a year. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

The hospitalization reimbursement standard is related to the hospital level where the insured lives:

Note: If you live in a tertiary hospital.

1, from qifubiaozhun to 30,000 yuan, the employee pays 15%, which means 85% reimbursement;

2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;

3. 95% of the part exceeding the maximum payment limit of 40,000 yuan can be reimbursed, as long as the employee pays 5%;

4. Retirees pay 60% of the employees.

Outpatient treatment guarantee policy:

(1) Scope of outpatient service. The general outpatient department does not set specific diseases as a whole. Outpatient chronic diseases and special diseases shall be uniformly set in the whole province (specific diseases shall be formulated separately), and the transition from disease protection to cost protection shall be gradually made.

(2) Overall planning of general outpatient service. Qifubiaozhun is calculated cumulatively according to the natural year, with the maximum not exceeding 300 yuan, and the specific standards are determined by the overall planning areas. The proportion of on-the-job employees' overall payment in general outpatient service, secondary medical institutions and tertiary medical institutions in the first-level and below medical institutions is 60%, 55% and 50% respectively, and the proportion of inclined payment for retirees is consistent with the proportion of hospitalization funds in the overall planning area. The annual maximum payment limit of the overall planning fund shall not exceed 2000 yuan, and the specific standards shall be determined by each overall planning area.

(3) Outpatient chronic diseases. Combined calculation of outpatient chronic diseases and general outpatient co-ordination Qifubiaozhun. The proportion of payment is set at 60% and 70% in principle, which is determined by the overall planning area. The maximum annual payment limit of the overall fund shall not exceed 6500 yuan. The overall planning area can be combined with the actual situation, according to the disease set specific overall fund annual maximum payment limit.

(4) Outpatient special diseases. Qifubiaozhun is consistent with Qifubiaozhun at the same level in principle. Qifubiaozhun is calculated once in a natural year, and Qifubiaozhun is calculated for outpatient treatment of special diseases in designated medical institutions at higher levels. The proportion of payment is implemented according to the proportion of hospitalization payment of designated medical institutions at the same level. The annual maximum payment limit of the overall fund and the annual maximum payment limit of hospitalization are calculated together.

(5) Emergency rescue. Outpatient emergency (including emergency observation) and rescue medical expenses that meet the requirements are implemented according to the hospitalization payment policy of designated medical institutions at the same level, and the annual maximum payment limit of the overall fund and the annual maximum payment limit of hospitalization are calculated together.

(6) daytime surgery. If the related day surgery is managed by cash basis, there is no deductible line, and the payment ratio is implemented according to the proportion of hospitalization payment in designated medical institutions. The annual maximum payment limit of the overall fund and the annual maximum payment limit of hospitalization are calculated together.

Legal basis:

Notice of Jilin Provincial Medical Security Bureau and Jilin Provincial Department of Finance on clearly implementing the relevant requirements for establishing and improving the economic security mechanism for employees' basic medical insurance outpatient service

Second outpatient treatment security policy

(7) Dynamic adjustment. The relevant treatment of employee medical insurance outpatient service can be dynamically adjusted according to the local economic and social development and the actual situation of fund operation.

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