The 2023 health insurance reimbursement policy is as follows:
1. The unified health insurance reimbursement ratio will be adjusted to 80%, covering items mainly including inpatient costs, outpatient costs, drug costs, etc.
2. Increasing inpatient reimbursement items, health insurance organizations will add large equipment inspection and medical institution management costs to the inpatient reimbursement items in order to better Protect patients' rights and interests in medical treatment;
3. Improve the outpatient coordination treatment, the insured residents in the second level and the following designated medical institutions in the general outpatient medical expenses, the reimbursement of one year the ceiling line of 150 yuan / person year, reimbursement rate of 60%, the implementation of network direct settlement. In addition, according to the current health insurance reform has been completed in the region, health insurance personal account into the account may be less, because the reform is no longer transferred to the 30% borne by the enterprise unit, just transfer only 2% deducted by the individual. The payment limit. 2023 residents health insurance integrated fund annual maximum payment limit of the first tranche of 200,000 yuan, the second tranche of 250,000 yuan, 2023 adjusted to "residents health insurance integrated fund annual payment limit of 250,000 yuan.
Medicare coverage is as follows:
1, the drugs are divided into three categories of A, B and C, of which Category A drugs are within the scope of the medical insurance, so only Category A drugs can be reimbursed by the medical insurance, while Category B and C can not be reimbursed;
2, reimbursement mainly refers to the insured person, in the medical insurance designated institutions for diagnosis and treatment and nursing care, and in the process The reimbursement is mainly for the insured's medical treatment and care in the designated hospitals in the process of which the insured's bed charges, emergency bed charges and consultation fees are incurred.
Summary of the above is the editor of the new regulations on health insurance reimbursement 2023 to make the relevant answer, I hope it can help you.
Legal basis:
The People's Republic of China **** and the State Social Insurance Law, Article 28
Conforms to the basic medical insurance drug directory, diagnostic and therapeutic items, medical service facility standards, as well as emergency, rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug 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.