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Can outpatient treatment be reimbursed?

compensation

First, the scope of outpatient medical insurance reimbursement

The coverage of outpatient medical insurance includes myasthenia gravis, polymyositis and dermatomyositis, systemic lupus erythematosus, psoriasis (pustular psoriasis, arthropathy psoriasis, erythroderma psoriasis), dysplasia syndrome, polycythemia vera,

Antitumor drug therapy for Behcet's disease, aplastic anemia, hemophilia, chronic hepatitis B and its compensatory cirrhosis (antiviral therapy), chronic hepatitis C (antiviral therapy) and malignant tumor.

After the establishment of the basic medical insurance system, the outpatient registration fee, outpatient consultation fee, injection fee (including intramuscular injection, intravenous injection, subcutaneous infusion, intravenous infusion, and scalp intravenous infusion for children) and pharmaceutical service fee will be merged into the general consultation fee, and the pharmaceutical service fee will no longer be established separately, and the merged original project fee standard will no longer be implemented. These general medical expenses can be paid by the public medical insurance fund in the future.

Warm reminder: the amount of prescription drugs used by the insured in outpatient service of designated medical institutions should not exceed 3 days for acute diseases, 7 days for common chronic diseases, and 30 days for patients with special chronic diseases and stable conditions who need to take the same drug for a long time. The basic medical expenses incurred in outpatient service and emergency treatment are deducted from the personal account, and when the personal account is insufficient to pay, the insured shall pay by himself.

Two, employee medical insurance outpatient reimbursement ratio:

After the on-the-job employees see a doctor in the outpatient and emergency department of the hospital, the medical expenses of more than 2,000 yuan can be reimbursed, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%.

For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 500 yuan can reimburse 50%, that is, 250 yuan.

Proportion of reimbursement for outpatient special diseases

Medical insurance for employees: within a medical insurance year, the reimbursement rate of medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization. In 400 yuan, the deductible line of special disease outpatient service.

Medical insurance for urban and rural residents: within a medical insurance year, the proportion of reimbursement for medical expenses that meet the prescribed treatment scope is the same as that of ordinary hospitalization. In 400 yuan, the deductible line for special disease clinics.

At present, outpatient special disease 12.

1, malignant tumor;

2, uremia outpatient renal dialysis;

3. Outpatient treatment after tissue and organ transplantation;

4. Organ failure (heart, lung, liver, kidney); (5) Recovery period of cerebrovascular accident;

5, hypertension phase III (one of the complications of heart, brain, kidney and eye;

6. Diabetes (complicated with infection or complications of heart, kidney, eyes and nervous system);

7. Chronic aplastic anemia;

8. Systemic lupus erythematosus (one of the complications of heart, lung, liver, kidney and nervous system);

9. Severe mental disorder;

10, hemophilia; (12) Chronic hepatitis B (active hepatitis B), hepatitis B cirrhosis and chronic hepatitis C (17 data from a certain place)

Extended data:

Employee medical insurance reimbursement

First, the basic insurance does not pay the cost of the scope of medical treatment projects.

(1) service items

1, registration fee, out-of-hospital consultation fee, medical record fee, etc.

2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and special care by oneself.

(2) Non-disease treatment projects

1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;

2. Various weight loss, weight gain and height increase projects;

3. Various health checks;

4, all kinds of prevention and health care projects;

Medical insurance reimbursement

1, registration fee, out-of-hospital consultation fee, medical record fee, etc.

(2) Non-disease treatment projects

1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;

2. Various weight loss, weight gain and height increase projects;

3. Various health checks;

4, all kinds of prevention and health care projects;

5, tooth deformity, dental porcelain;

6, all kinds of medical consultation (excluding psychiatric consultation), medical appraisal.

(3) Diagnostic equipment and medical materials.

1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;

2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;

3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.

(4) Treatment items

1, the organ source or tissue source of various organ transplants or tissue transplants;

2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;

3. Orthopedic surgery for myopia;

4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.

(5) Others

1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;

2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;

Two, the basic medical insurance to pay part of the cost of diagnosis and treatment project scope

(a) diagnosis and treatment equipment and medical materials

1, X-ray computed tomography (CT) for examination and treatment, stereotactic radiation devices (γ knife and χ knife), cardiac and angiographic X-ray machines (including digital subtraction equipment), magnetic resonance imaging devices (MEI), single photon emission computerized scanning devices (SPECT), color Doppler instruments, medical linear accelerators and other large medical equipment.

2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;

3. Pacemakers, artificial joints, intraocular lenses, vascular stents, etc. replace artificial organs in vivo and place materials in vivo;

4, the provisions of the provincial price department can be charged separately for disposable medical materials.

(2) Treatment items

1, hemodialysis, peritoneal dialysis;

2. Transplantation of kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow;

3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.

Hearing AIDS and other rehabilitation equipment;