1, general outpatient treatment:
(1) Payment scope: Class A and Class B drugs in the residents' medical insurance drug list, as well as approved diagnosis and treatment projects and medical service facilities that pay part of the expenses;
(2) The maximum payment limit is 150 yuan, and there is no deductible line, which is limited to use in the current year, and will not be carried forward and accumulated in the next year;
(III) Full-time college students' general outpatient medical care shall be co-ordinated by the school as a unit in accordance with the regulations, and the medical insurance agency shall allocate the outpatient medical expenses fund to the school in accordance with the regulations, which shall be uniformly managed by the school and used in a lump sum manner.
2, "two diseases" outpatient medication security benefits:
(1) The limit standard of the monthly overall fund is 40 yuan (the annual cumulative reimbursement amount of patients with hypertension complicated with diabetes/diabetes complicated with hypertension is not calculated repeatedly);
(2) Outpatient medication expenses paid by urban and rural residents' medical insurance co-ordination fund are not included in the annual limit of residents' medical insurance outpatient co-ordination and the annual maximum payment limit of hospitalization co-ordination fund. For patients with relatively stable condition, the dosage of a prescription can be extended to 3 months after the doctor's evaluation to ensure the patient's drug demand.
Required information:
1, the original medical insurance card and its front and back copies;
2. The original invoice for hospitalization is stamped with the seal of the charging business of the medical institution;
3. Detailed summary list of hospitalization;
4, medical institutions stamped diagnosis proof materials;
5, the first page of hospital medical records or admission records;
6. A copy of the discharge summary is stamped with the special seal for medical records management of medical institutions.
To sum up, the high medical expenses incurred by the insured patients in the basic medical insurance year, after being compensated by the basic medical insurance, can enjoy the compensation of serious illness insurance for the part that the individual bears the compliance medical expenses exceeding 654.38+0 million yuan, and there is no capping line.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.