In accordance with the provisions of Article 13 of the Measures for the Implementation of the Basic Medical Insurance for Urban and Rural Residents in Henan Province (Trial), a general outpatient medical co-ordination system shall be established. All localities can set up an outpatient co-ordination fund according to about 50% of the local per capita payment, which is mainly used to pay the general outpatient medical expenses (including general medical expenses, the same below) incurred by insured residents in designated medical institutions at the grassroots level.
There is no Qifubiaozhun for outpatient co-ordination, and the reimbursement rate is about 60%. The accumulated reimbursement amount during the year is controlled at about 2 times of the local per capita payment. At present, it does not have the conditions to establish the outpatient co-ordination system, but it still adopts the family account method to pay the general outpatient medical expenses. The amount included in family account refers to the per capita standard of outpatient co-ordination. Family account should gradually transition to outpatient co-ordination, and specific measures shall be formulated by all provinces and cities.
According to the provisions of Article 21 of the Measures for the Implementation of the Basic Medical Insurance for Urban and Rural Residents in Henan Province (Trial), the following medical expenses are not included in the payment scope of the medical insurance fund for urban and rural residents:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party fails to pay or cannot determine the third party, it shall be paid in advance by the urban and rural residents' medical insurance fund. Urban and rural residents' medical insurance fund has the right to recover from the third party after paying in advance.
Extended data:
The economic development in different regions is different, so the reimbursement ratio is different. Take the proportion of employees' medical insurance in Beijing as an example. After the employees pay the medical insurance, if they are on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed after the emergency treatment in the hospital, and the reimbursement ratio is 50%.
For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.
However, the following items will not be reimbursed:
(1) service items. (1) Registration fee, out-of-hospital consultation fee, medical record fee, etc. (2) Special medical services, such as visiting fees, expedited fees for examination and treatment, additional fees for roll-call surgery, high-quality and low-price fees, and self-invited intensive care.
(2) Non-disease treatment projects. (1) all kinds of beauty and bodybuilding, as well as non-functional plastic surgery and orthopedic surgery; (2) various weight loss, weight gain and height increase projects; (3) various health checks; (4) all kinds of preventive health care and diagnosis projects; (5) all kinds of medical consultation and medical appraisal.
(3) Diagnostic equipment and medical materials. (1) Examination and treatment items of large medical equipment such as positron emission tomography (PET), electron beam cT and ophthalmic excimer laser therapeutic instrument; (2) glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation devices; (3) all kinds of self-use health care, massage, examination and treatment equipment.
(4) Treatment items. (1) The organ source or tissue source of various organ or tissue transplants; (2) Transplantation of organs or tissues other than kidneys, heart valves, corneal skin, blood vessels, bones and bone marrow; (3) Orthopedic surgery for myopia; (4) Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) others. (1) various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects; (2) all kinds of scientific research and clinical verification of diagnosis and treatment projects.
People's Government of Henan Province-Measures for the Implementation of Basic Medical Insurance for Urban and Rural Residents in Henan Province (for Trial Implementation)
Baidu encyclopedia-medical insurance reimbursement ratio