1, outpatient and emergency medical expenses. For the medical expenses of employees in medical insurance coverage in that year (65438+1 October1to 65438+February 3 1) exceeding 2,000 yuan, the proportion of reimbursement by dispatched personnel during the contract period is 50%, and the individual pays 50%. The maximum reimbursement for outpatient and emergency services paid by dispatched personnel within one year is 20,000 yuan.
2. The insured shall properly keep the medical documents in the outpatient department of the designated hospital, including the following parts such as large receipts and prescriptions. , as a medical expense reimbursement voucher.
3. Outpatient treatment of three special diseases. Including radiotherapy and chemotherapy for malignant tumors, renal dialysis, taking anti-rejection drugs after kidney transplantation, etc. Outpatient treatment and drug collection of these diseases are limited to designated hospitals approved for treatment and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.
Jining medical insurance reimbursement process in 2024;
1. Outpatient service: The patient carries his/her ID card (or social security card, medical card, medical insurance electronic certificate) to register at the registration window, and the triage desk, consultation room, and charging window can be settled by one-stop medical insurance and directly reimbursed.
2. Hospitalization: The patient carries the ID card (or social security card) and hospitalization notice to go through the hospitalization formalities, and carries out one-stop medical insurance settlement at the window of the charging office (hospitalization office) when leaving the hospital.
To sum up, the reimbursement method of medical insurance in Jining City in 2024 provides detailed guidelines for the medical expenses compensation of insured residents, including the minimum payment standard, reimbursement ratio and annual maximum payment limit of serious illness insurance, as well as the treatment standard of chronic diseases in outpatient clinics.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
The basic medical insurance fund shall pay medical expenses in accordance with the basic medical insurance drug list, diagnosis and treatment project list and service facilities standard. The specific scope and standard of payment shall be formulated by the administrative department of medical security of the State Council in conjunction with the financial department of the State Council.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.