1, in a natural year, "residents" to see the outpatient clinic within 200 yuan of the cost borne by the individual, between 200-900 yuan of the cost of community hospitals to pay 60% of the fund, in other hospitals to pay 50% of the fund;
2, For residents over 80 years old, the fund pays 65% of the cost of consultation at community hospitals and 55% at other hospitals, while the cost above 900 yuan is borne by the individual;
3. The fund pays 60% of the cost of outpatient consultation between 0 and 400 yuan for "students and children" at community hospitals;
4. The fund pays 50 percent of the medical fees for visits to other hospitals, and the individual bears the cost of fees above 400 yuan.
Medical insurance reimbursement scope and standard:
1, drugs are divided into Class A, Class B and Class C drugs, of which Class A drugs are necessary for clinical treatment and widely used, and the drug costs of these drugs are all reimbursed according to the proportion stipulated by the medical insurance. Class B drugs are first paid a certain percentage, and then reimbursed by the health insurance, the specific reimbursement rate is different in different places of the health insurance bureau regulations are different;
2, diagnosis and treatment items refers to the hospital for treatment, the use of medical instruments, equipment and medical materials, mainly two ways to reimbursement of the full co-ordination of all the items are all included in the health insurance reimbursement, according to the prescribed proportion of payment. The first part of the integrated project, is to pay a part of the first, and then reimbursement according to the prescribed proportion;
3, medical service facilities standard, refers to the hospital bed fee, outpatient hospital bed fee and so on, the reimbursement scope and standard is different from place to place. If the social security of the medical insurance reimbursement scope is for the medical insurance catalog within the project reimbursement, including drugs, diagnostic and treatment items and medical service facilities.
Legal basis: Article 2 of the Social Insurance Law of the People's Republic of China
The State establishes a social insurance system for basic pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., to protect citizens' rights to obtain material assistance from the State and society in the event of old age, illness, industrial injury, unemployment or maternity. The right to receive material assistance from the State and society in cases of old age, sickness, industrial injury, unemployment and maternity.
Article 28
Medical expenses that conform to the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with state regulations.