1, general outpatient treatment:
(1) the scope of payment: the residents of the medical insurance drug catalog of Class A, Class B drugs, as well as permitted to pay for diagnostic and therapeutic items and part of the cost of the diagnostic and therapeutic items, medical services facilities;
(2) the maximum payment limit of 150 yuan, there is no minimum payment line, the limit is limited to the current year. The outpatient medical care for full-time students in colleges and universities shall be coordinated on a school basis according to the regulations, and the medical insurance agency shall allocate the outpatient medical fee coordination fund to the school according to the regulations, which shall be managed by the school and used on a lump-sum basis.
2, "two diseases" outpatient medication protection treatment:
(1) monthly integrated fund limit standard is 40 yuan (hypertension combined diabetes / diabetes combined hypertension patients annual cumulative reimbursement will not be double-counted);
(2) by the urban and rural residents' medical insurance integrated fund payment (2) The outpatient medication costs of patients with "two diseases" are not counted as part of the annual limit of outpatient co-ordination of residents' medical insurance and the annual maximum payment limit of inpatient co-ordination fund. For patients with relatively stable conditions, a single prescription can be extended to three months after assessment by a doctor to safeguard patients' medication needs.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
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.