From October 1st, the general outpatient policy of medical insurance has been adjusted

Yangjiang Day News (Reporter/Wu Xiaoxia) From October 1st, the overall policy of employees and urban and rural residents' medical insurance general clinics will be newly adjusted. How can insured persons enjoy the reimbursement of ordinary outpatient clinics? What is the proportion of reimbursement? Regarding the concerns of the participants, the reporter interviewed the relevant personnel of the Municipal Medical Insurance Bureau.

Improvement of ordinary outpatient treatment standards

According to reports, whether it is an employee or the insured of urban and rural residents, the amount of reimbursement of the ordinary outpatient clinic does not set up a line of payment, and the treatment standards are improved. Among them, the proportion of employees' medical insurance at the township health centers, community health service centers, and village health stations are 70%of employees and 75%of retired employees. The payment ratio of designated medical institutions is 55%of the employees, 60%of retired employees, and the percentage of the third -level designated medical institution is 50%of the employees and 55%of the retired employees. The monthly limit from October to December 2022 was 145.33 yuan/person · month, and the monthly limit of 2023 was 151.33 yuan/person · month.

Urban -rural residents within the scope of policy expenses within the policy scope of the rural health centers, community health service centers and village health stations are 60%. The monthly limit from October to December 2022 is 116.25 yuan/person · month. The limit is 121.08 yuan/person · month, and the monthly payment limit does not conclude.

It should be noted that employees' medical insurance insurers at the first, secondary, and third -level medical institutions are required to be referred to the referral form and go through the referral procedures for reimbursement.

Select 1 grass -roots designated medical institution

"Insured personnel can only select 1 medical institution among the 50 grass -roots medical institutions designated by our city to enjoy ordinary outpatient treatment." The relevant person in charge of the Municipal Medical Insurance Bureau introduced that whether it is employee medical insurance insurer or urban and rural residents Medical insurance insurers should choose 1 in the city's 50 households or community health service centers in advance in accordance with the principle of nearby principles, as a designated hospital for their ordinary outpatient clinics. After selecting a designated hospital, it will not be changed within one year.

After the employee's medical insurance and urban and rural residents' medical insurance insured completed the filing point, the selected grass -roots hospitals can directly realize the network settlement. Insured personnel only need to pay the individual's pay for some fees. Except for emergency and rescue needs, if the insured persons are not reimbursed for general outpatient medical expenses, the general outpatient medical expenses will not be reimbursed.

However, insured persons who have handled long -term residence procedures in different places should seek medical treatment in the township health centers or community health service centers in different places. There is no need to go through the filing procedures for the selection point. In the hospital where the insured person has opened a different place for outpatient clinics, the insured person can directly implement the network settlement in the hospital where the medical hospital has not opened the outpatient network settlement function of a different place. The expenses can be reimbursed by the insured person to apply for sporadic reimbursement to the medical insurance agency of the participating place.

Optional online or offline way to record

"Insured personnel can be selected by online or offline." The person in charge introduced that at present, the insured persons have three ways to go through the fixed medical institution filing procedures: First, when the insured person is medical treatment, it can be The service window of the service window of the outpatient toll office of the township health centers or community health service centers is directly recorded, and the grass -roots hospital directly uploads the filing information of the participating candidates to the medical insurance information system for the record. The second is that the insured persons directly go to the service window of the medical insurance agency to apply for an artificial outpatient selection point for the record. Third, insured personnel log in to the WeChat mini -programs "Guangdong Medical Insurance" into the medical insurance electronic voucher, and the "outpatient selection registration" module in the "business processing" module of Guangdong Medical Insurance is filled in the selection point.

If the insured person needs to change the designated hospital due to special reasons such as residential migration, it can submit a certificate of residential migration to the service window of the designated medical institution at the grassroots level. The medical insurance agency can take effect after approval by the approved by the medical insurance office; the insured person can also directly hold the certificate of migration of the residential place, and apply for the application for manual changes in the service window of the medical insurance agency in the city.

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