Insurance and sales policy: By establishing an employee basic medical insurance system with mutual assistance, economy and responsibility, the structure of the employee basic medical insurance fund will be adjusted (that is, "one increase, one decrease") to solve the problem of insurance participation. Regarding the issue of personnel outpatient protection, we should increase the accessibility of outpatient reimbursement under the basic medical insurance for employees.
Reimbursement voucher: present one of the three electronic medical insurance vouchers, ID card, or social security card.
Settlement method: Medical expenses are settled directly at the hospital, and insured persons only need to pay their own out-of-pocket expenses; expenses paid by the outpatient overall fund shall be settled by the hospital and each medical insurance bureau in accordance with the provisions of the agreement.
Reimbursement scope: 1. The outpatient and emergency medical expenses incurred by insured persons at designated medical institutions shall be included in the outpatient overall reimbursement.
2. The reimbursement scope is consistent with the basic medical insurance reimbursement scope, that is, the basic medical insurance drug catalog, medical service item catalog and medical consumable catalog stipulated by the country, province and city. Reimbursement will not be made if it is outside the reimbursement scope of basic medical insurance.
3. Employees insured by employee medical insurance do not enjoy outpatient overall reimbursement during hospitalization, but can enjoy reimbursement the day after discharge.
4. Patients who enjoy special clinics and fertility clinics will still follow the original implementation path.
5. The cost of outpatient nucleic acid testing is not included in the general outpatient overall policy payment.
Situations in which medical insurance will not reimburse:
1. It should be paid from the work-related injury insurance fund;
2. It should be borne by a third party;
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3. Should be borne by the public health;
4. Seeking medical treatment abroad;
5. Sports and fitness, health care consumption, health examination, Cosmetology and plastic surgery, etc.;
6. Other expenses that are not covered by the national medical insurance fund;
7. Including expenses below the deductible line, above the cap line, and outside the medical insurance catalogue, etc. ;
8. Parts beyond the medical insurance catalog: drug catalog, diagnosis and treatment item catalog, and service facility catalog.
Outpatient coordination and reimbursement process
Registration: You can make an appointment through the hospital’s WeChat official account, register with the automatic number-taking machine in the hospital lobby, or register at the hospital’s manual window.
Visit a doctor: Go to the clinic to see a doctor who will prescribe examination and treatment based on your condition, and proactively inform the doctor of your medical insurance type.
Settlement: Do not pay by yourself on WeChat. Please bring one of the three electronic medical insurance vouchers, ID cards, and social security cards to the manual payment window in the outpatient hall to handle reimbursement procedures.
Legal basis:
Article 28 of the "Social Insurance Law of the People's Republic of China" complies with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency, The medical expenses for rescue shall be paid from the basic medical insurance fund in accordance with national regulations.