1, Shanxi Province will implement a new medical insurance reimbursement policy, stipulating that the reimbursement amount will no longer be affected by government subsidies, but will be determined according to the actual expenses paid by patients;
2. The reimbursement standard for reimbursement of drugs will be determined according to the category and quality of drugs, and the reimbursement ratio can reach up to 90%;
3. Reimbursement expenses will be determined according to the patient's condition and treatment plan, and the maximum reimbursement amount can reach 50%;
4. Shanxi Province will establish a medical insurance reimbursement information platform to collect and enjoy reimbursement information. By implementing these new regulations, Shanxi Province will better protect patients' medical rights and interests, improve the efficiency and convenience of medical insurance reimbursement, and better meet patients' medical needs.
Recently, Shanxi Province issued a new policy of basic medical insurance for urban workers and basic medical insurance for residents to improve the level of urban medical insurance benefits. Within the scope of the policy, the average reimbursement rate of medical insurance in Shanxi increased by 10%, and the maximum reimbursement amount increased by more than 30,000 yuan on average. At the same time, the payment scope of employee medical insurance personal accounts has been further expanded.
The specific adjustment is: increase the maximum reimbursement limit and payment ratio. The maximum reimbursement limits for employee medical insurance and resident medical insurance were raised from 200,000 yuan and 70,000 yuan to 230,000 yuan and 654.38+10,000 yuan respectively. At the same time, when the insured is hospitalized in the designated medical institutions with one, two, three and below charges, the medical expenses that meet the requirements are reimbursed by the employee medical insurance pooling fund by 75%, 85% and 90% respectively, and the average reimbursement ratio is increased from 73% to 83%. Residents' medical insurance is reimbursed by 60%, 70% and 85% respectively, and the average reimbursement rate has increased from 60% to 70%.
The payment line standard is lowered. When the insured is hospitalized in the designated medical institutions with class I, class II, class III and below charges, the deductible standards of the employee medical insurance pooling fund are 800 yuan, 500 yuan and 300 yuan respectively, which is 7% lower than before adjustment. 6 percentage points.
Can Shanxi outpatient service be reimbursed by medical insurance?
1, legal subjectivity: the provisions of medical insurance reimbursement in Shanxi Province are as follows: the proportion of reimbursement for urban residents: first-class hospitals: 85%; Secondary hospitals: 70%; Tertiary hospitals: 60%; Emergency hospitalization: 50%; Referral from tertiary hospitals in different places: 55%.
2. Subjectivity of law: If medical insurance can reimburse outpatient expenses, then the reimbursement scope of medical insurance includes outpatient expenses, hospitalization expenses and serious illness. However, the proportion of outpatient reimbursement is less than the other two items.
3, the insured workers in the designated medical institutions outpatient medical treatment required drugs can not meet, to the designated medical institutions prescription in outpatient co-ordination designated retail pharmacies to buy drugs, in line with the provisions of the drug costs can also enjoy outpatient co-ordination reimbursement, Qifubiaozhun, fund payment ratio according to the designated medical institutions prescription level execution.
4, medical insurance is divided into two accounts, personal account, the money reflected in the medical insurance card, can be used to buy medicine in designated pharmacies, outpatient expenses and hospitalization expenses paid by individuals; The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account.
5. Article 9 The general outpatient medical expenses of the insured employees, above the Qifubiaozhun and below the maximum payment limit, shall be shared by the overall fund and individuals.
6. For those who have gone through retirement procedures, if they cannot enjoy medical insurance treatment temporarily due to insufficient payment period, they can also make up the difference at one time according to the regulations, and make up the medical expenses incurred from that month according to the regulations.
I hope the above content can help you. If in doubt, please consult a professional lawyer.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29 of People's Republic of China (PRC) Social Insurance Law
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.