1, general outpatient reimbursement: general outpatient expenses incurred in primary designated medical institutions, there is no starting line, a certain percentage of the payment, the maximum reimbursement per person per year 200 yuan.
2. Chronic disease outpatient reimbursement: residents suffering from hypertension, diabetes and other chronic diseases will be reimbursed 60% of the cost of medicines for lowering blood pressure and lowering blood glucose incurred in outpatient clinics of primary healthcare institutions at the second level or below, with a maximum reimbursement limit of RMB 300 yuan in a natural year.
3. Outpatient reimbursement for special diseases: the implementation of the province's unified outpatient special diseases, the reimbursement rate is 60%, and the amount of annual medical expenses within the scope of the policy within a natural year can not exceed 6,500 yuan.
4, accidental injury outpatient reimbursement: students, children and non-school urban and rural residents under 18 years of age, the annual accidental injury of the compliant outpatient medical expenses, more than 100 yuan (excluding 100 yuan) 5,000 yuan (including 5,000 yuan) the following part of the reimbursement rate of 80%.
5, outpatient co-ordination: urban residents' health insurance will soon start outpatient co-ordination, the maximum amount of 200 yuan per person per year, the required funds according to the students (including primary and secondary school students) 20 yuan / year, children, non-employed and the elderly 30 yuan / year standard, from the urban residents' health insurance co-ordination fund.
Materials for outpatient medical insurance reimbursement
1, original ID card and social security card.
2. The original certificate of diagnosis of the disease issued by a specialist doctor at a tertiary or secondary hospital of the designated medical institution.
3. Original medical documents such as report cards of outpatient, examination and test results.
4. Original receipts of outpatient charges of financial and tax unified medical institutions.
5. The original computer-printed list of outpatient fees or the original payment of the prescription issued by the doctor.
6, designated pharmacies: tax unified invoice for goods sales and the original computer-printed list.
7. In case of proxy, the original identity card of the proxy will be provided.
In summary: there is no starting line for reimbursement by insured residents at outpatient coordinated designated hospitals. Within the scope of the policy, the reimbursement rate is 60%, and the maximum reimbursement is 300 yuan in a year. There is also no starting line for outpatient medical expenses incurred in outpatient two-disease (hypertension and diabetes) designated hospitals. The reimbursement rate is 60% within the policy scope for first-level and lower medical institutions, and 50% for second-level medical institutions, with a maximum of 200 yuan in a year.
Legal basis:
The People's Republic of China Social Insurance Law
Article 28
Medical expenses in accordance with the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.