55% of the medical expenses incurred by the insured in the designated community health service institutions or primary medical institutions shall be paid by the outpatient co-ordination fund and 45% by individuals.

proportion and scope of hospitalization reimbursement:

proportion of hospitalization reimbursement for employee medical insurance. The reimbursement ratio of hospitalization "deductible to 5 yuan" in the original policy was raised from "8% on-the-job and 85% retired" to "85% on-the-job and 9% retired"; The reimbursement ratio of "more than 1, yuan to the maximum amount" will be increased from "85% on-the-job and 9% retired" to "9% on-the-job and 95% retired.

The following expenses incurred by the insured in designated medical institutions and retail pharmacies are included in the reimbursement scope of the basic medical insurance fund for urban residents:

1. Medical expenses for hospitalization;

2. Medical expenses within 7 days before emergency observation and hospitalization;

3. medical expenses that meet the requirements of special diseases in urban residents' outpatient clinics;

4. Other expenses that meet the requirements

Under what circumstances can't be reimbursed:

1. Medical expenses incurred in non-designated medical institutions without approval

2. Suicide and self-mutilation (mental illness) are excluded

3. Fighting, fighting, drinking, taking drugs and other injuries caused by crime or violation of the Law on Public Security Administration Punishment

Treatment for physical defects, etc.

6. Coverage of work-related injury insurance (including occupational diseases) or maternity insurance

7. Other cases of non-payment of expenses stipulated by national and provincial medical insurance policies

Scope and proportion of medical reimbursement for special chronic diseases in Nanning outpatient department

(1) Scope of diseases. 29 kinds of diseases, such as coronary heart disease, are uniformly identified as outpatient special chronic diseases in the whole region. For details, please refer to the payment table of outpatient special chronic disease medical expenses fund limit.

(2) Identification of special chronic diseases in outpatient department. Insured persons suffering from prescribed outpatient special chronic diseases shall be identified by designated medical institutions at or above the second level (county level), and shall be responsible for collecting relevant materials (including disease certificates issued by doctors with intermediate titles and above, outpatient medical records, inspection reports, laboratory tests, etc.), which shall be submitted by designated medical institutions to social insurance agencies on a regular basis for the record. The identification standard, identification time and handling process of outpatient chronic diseases shall be formulated by the overall planning area according to local conditions.

(3) Designated medical treatment. In principle, outpatient patients with special chronic diseases choose a grassroots designated medical institution as the designated outpatient medical service. The designated medical institution will be fixed for one year and will not be changed halfway. If the social insurance agencies in the overall planning area have the service ability, supervision ability and fee control ability, they can independently increase the service points of designated medical institutions.

(4) qifubiaozhun. The minimum payment standard of outpatient special chronic disease medical expenses fund is 2 yuan/person/month, which is deducted from the total amount paid by the fund.

(5) the proportion of reimbursement for medical expenses. The medical expenses incurred by outpatients with special chronic diseases in designated medical institutions in accordance with the scope of payment of basic medical insurance shall be shared by both the fund and the individual. For details, please refer to the table for sharing and paying medical expenses of basic medical insurance for outpatient special chronic diseases.

(6) If outpatients with special chronic diseases use Class B and Class C medicines in the Catalogue of Medicines and Medical Service Items of the basic medical insurance in designated medical institutions, they shall pay 15% and 3% by themselves first, and then pay according to the provisions of the basic medical insurance. Medical materials (including in-vivo materials) that can be charged separately as stipulated by the competent price department of the state and the autonomous region shall be subject to price classification management, and the following 2 yuan (including 2 yuan) shall be Class A medical materials; Above 2 yuan and below 5 yuan (including 5 yuan) are Class B medical materials; 5 yuan and above are Class C medical materials.

(7) For the insured persons of poor population who have established a file to treat outpatient special chronic diseases, the reimbursement ratio will be increased by 5% on the basis of the shared payment table for medical expenses of basic medical insurance for outpatient special chronic diseases.

the confirmation, necessary information and handling process of the poverty-stricken people who have set up the file card shall be formulated by the overall planning area according to local conditions.

(8) limit payment. The annual fund limit payment is implemented for each disease. For details, please refer to the fund limit payment table for outpatient special chronic disease medical expenses. Medical expenses exceeding the annual fund limit to pay the above part shall be paid by the individual.