1, unify the proportion of medical insurance reimbursement. After the implementation of the new regulations, the proportion of medical insurance reimbursement is uniformly adjusted to 80%, and the coverage items mainly include hospitalization expenses, outpatient expenses and drug expenses;
2. Increase hospitalization reimbursement items. After the implementation of the new regulations, medical insurance institutions will increase the inspection and management fees for large-scale equipment of medical institutions in hospitalization reimbursement projects to better protect patients' medical rights and interests;
3. Increase the proportion of drug reimbursement. In order to better protect patients' rights and interests in drug use, the new regulations increase the reimbursement rate of drugs to 90%, and divide drugs into three categories (chronic drugs, routine drugs and anti-infective drugs), and set different reimbursement rates according to different types;
4. Strengthen the supervision of reimbursement. After the implementation of the new regulations, medical insurance institutions will strengthen the supervision of reimbursement items. Any reimbursement application that does not meet the medical insurance reimbursement standards will be reviewed in time, and those who are irresponsible will be held accountable.
Medical insurance reimbursement process:
1, diagnosis and treatment in designated medical insurance hospitals: every city will have designated medical insurance hospitals, and only in designated medical insurance hospitals can medical insurance be used for reimbursement. Therefore, if you want to use medical insurance, you must go to the designated hospital for medical insurance and go through the relevant registration procedures;
2. Prepare discharge materials: prepare discharge materials in advance when leaving the hospital, such as disease diagnosis, discharge records, medical records, etc. Usually talk to the doctor during treatment. If we need these materials, the doctor will help us prepare them. You'd better make a copy of these materials after you get them. One is submitted to the medical insurance reimbursement office, and the other is reserved for use;
3. Discharge settlement: Take the hospitalization list and invoice and go to the hospital for settlement. After that, you can take the relevant information to the medical insurance reimbursement department for reimbursement review;
4. Waiting for expense reimbursement to arrive: After the materials are handed over, a receipt will be received, and the reimbursement amount will arrive in 15 days. You just have to wait patiently.
To sum up, when the insured workers in Inner Mongolia enjoy the overall treatment of general outpatient service, they will be paid by the overall fund in proportion, 60% by tertiary medical institutions, 80% by secondary and below medical institutions, and 5% by retirees.
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
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.