New regulations for medical insurance outpatient reimbursement

1. Original ID card or social security card;

2. Disease diagnosis certificate issued by a specialist at a designated medical institution Originals;

3. Originals of outpatient medical records, examinations, test results reports and other medical information;

4. Original outpatient fee receipts from unified financial and taxation medical institutions;

< p>5. A detailed list of outpatient expenses printed by the hospital computer or the original payer of the prescription issued by the doctor;

6. Designated pharmacies: the original uniform invoice for tax merchandise sales and the original list printed by the computer;

7. If you are applying on behalf of someone else, you need to provide the original ID card of the agent. Medical insurance reimbursement ratios vary in different regions, and are subject to local policies.

1. Elderly people over 70 years old. The prerequisite for medical insurance reimbursement is that it must meet the scope of medical insurance reimbursement, and the medical expenses incurred must be less than 100,000 yuan. In a billing year, first-level hospitals can reimburse up to 65%, and there will be no minimum payment standard. In second-level hospitals, the maximum reimbursement is 55%; in third-level hospitals, the maximum reimbursement is 50%, and a minimum payment standard of 500 yuan is also set.

2. Students or children. The prerequisite for reimbursement by resident medical insurance is that it must meet the reimbursement scope, and the medical expenses incurred must be less than 180,000 yuan. In a settlement year, the maximum reimbursement ratio for first-level hospitals is 65%, and there will be no reimbursement or minimum payment standards. Second-level hospitals can reimburse up to 60%, and third-level hospitals can reimburse up to 55%.

3. Urban and rural residents of other age groups. The prerequisite for reimbursement by resident medical insurance is that it must meet the reimbursement scope, and the medical expenses incurred must be less than 100,000 yuan. In a billing year, first-level hospitals can reimburse up to 60%, and there will be no minimum payment standard. Second-level hospitals can reimburse up to 55%; third-level hospitals can only reimburse up to 50%.

Legal basis: "Social Insurance Law of the People's Republic of China"

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions and government subsidies.

The government will subsidize the personal contributions required by people who enjoy the minimum living security, disabled people who have lost the ability to work, elderly people over 60 years old and minors from low-income families.