The outpatient reimbursement is with the money inside the personal account. You can bring your health insurance card directly to the designated hospital to settle the bill, and you can't be reimbursed for the out-of-pocket expenses. Medical expenses in accordance with the basic medical insurance drug catalog, diagnostic and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, will be paid from the basic medical insurance fund in accordance with national regulations.
Medical insurance reimbursement ratio:
1. Outpatient and emergency medical expenses: the part of medical expenses in line with the scope of the basic medical insurance regulations exceeding 2,000 yuan in total during the year of an active employee (January 1-December 31);
2. Settlement ratio: the part of the dispatched personnel exceeding 2,000 yuan in the contract period is reimbursed by 50%, and the individuals pay for it by themselves by 50%; the part of the dispatched personnel exceeding 2,000 yuan is paid for by the dispatched personnel in total during the year. The maximum amount of outpatient and emergency reimbursement paid to the dispatched personnel in a year is 20,000 yuan;
3. The insured personnel should keep the outpatient medical receipts (including receipts for the part below the large amount and the bottom of the prescription, etc.) of the outpatient medical treatment in the designated hospitals as the vouchers for reimbursement of the medical expenses;
4. Outpatient medical treatment for the three kinds of special illnesses: the outpatient medical treatment for participants suffering from malignant tumors with radiation therapy and chemotherapy, renal dialysis, kidney transplantation with anti-viral drugs, etc. 4, three special diseases: participants suffering from malignant tumor radiation therapy and chemotherapy, kidney dialysis, kidney transplantation to take anti-rejection drugs need to be outpatient medical treatment, by the participants in the second and third-class designated hospitals for medical treatment to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the district health insurance center for approval and filing. Outpatient medical treatment and medication collection for these three special diseases are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are in line with the scope of outpatient special diseases, they will be settled with reference to hospitalization;
5. Inpatient medical care. The medical insurance payment is enough for 20 years in order to enjoy the medical insurance reimbursement after retirement. The scope of the reimbursement rate of medical insurance varies from place to place, please refer to the local policy regulations.
Legal basis
The People's Republic of China Social Insurance Law
Article 29 The portion of the medical expenses of the insured persons which shall be paid by the basic medical insurance fund shall be settled directly by the social insurance administration organization with the medical institutions and the pharmaceutical business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.