Taking medical insurance for employees in Fuzhou as an example, the deductible line was reduced from 1.500 yuan to 800 yuan, and the ceiling line was increased from 1.000 yuan to 20,000 yuan. The proportion of reimbursement for on-the-job personnel has increased from 60% to 75%, and the proportion of reimbursement for medical treatment in primary medical institutions is 85%; The reimbursement rate of retirees has increased from 70% to 80%, and the reimbursement rate of primary medical institutions is 90%.
With the implementation of the New Deal, the public has some questions about the medical insurance policy. The reporter directly docked with Fujian Medical Insurance Bureau to help you answer questions. ↓↓↓
Q: Xiao Chen participated in employee medical insurance in Fuzhou. He wants to know that every time he goes to see a doctor, he must exceed the 800 yuan deductible line before medical insurance can be reimbursed. You can only spend more than 300 per visit. What if I can't reach the deductible?
Fujian Provincial Medical Insurance Bureau: The deductible line refers to the starting point for the medical insurance pooling fund to compensate the insured for the medical expenses that fall within the scope of the policy. To put it simply, medical insurance can only be reimbursed according to regulations when a certain fee is reached when seeing a doctor. The deductible line for general outpatient service is calculated on an annual basis, starting from 65438+1 month1every year. After the medical expenses within the policy reach 800 yuan within the year, they can enjoy medical insurance reimbursement. There is no need to exceed the deductible for every visit.
Q: But I spent a total of 850 yuan on outpatient service this year. Why hasn't my medical insurance been reimbursed?
Fujian Provincial Medical Insurance Bureau Answer: Only medical expenses within the normal scope of medical insurance can be included in the deductible line of general outpatient service for accumulation. Assuming that among the total outpatient expenses in 850 yuan, 780 yuan is within the scope of medical insurance policy and 70 yuan is outside the scope of medical insurance policy, then the deductible line of general outpatient service is accumulated in 780 yuan, which has not reached the deductible line of 800 yuan for the time being, so medical insurance is not reimbursed.
Q: I heard that there is no deductible line in the community health service center?
Fujian Provincial Medical Insurance Bureau answers: The insured uses the national essential drugs that have been included in the national medical insurance drug list in the basic public medical institutions designated by medical insurance (mainly including community health service centers and township hospitals). There is no deductible line in general outpatient service, and medical insurance is reimbursed according to regulations (not included in the cumulative deductible line of general outpatient service), and the reimbursement ratio is higher than that of relatively large hospitals. Therefore, it is more cost-effective to go to primary public medical institutions for treatment of common diseases such as colds, coughs and diarrhea.
Q: I have friends who work in Quanzhou, and their outpatient deductibles seem to be different from those in Fuzhou.
Fujian Medical Insurance Bureau's answer: According to the Implementation Opinions on Improving the Economic Security Mechanism for Employees' Basic Medical Insurance Outpatients, in principle, the annual deductible line is determined by 1% of the average salary of employees in local full-caliber urban units, so the deductible line for general outpatient clinics varies from place to place. Please consult the medical insurance agency of the insured place for the specific standard of deductible line for general outpatient clinics in other cities.
Consultation telephone numbers in all parts of Fujian:
Provincial level: 0591-12345 to 6.
Fuzhou: 0591-12345 to 7
Xiamen: 12333 transferred to medical insurance group
Ningde: 0593- 12345 transferred to medical insurance
Putian: 0594- 12345 to 2
Quanzhou: 0595- 12345 turn 1 turn 2.
Zhangzhou: 0596- 12345 transferred to medical insurance.
Longyan: 0597- 12345 transferred to medical insurance.
Sanming: 0598- 12345 transferred to medical insurance.
Nanping: 0599- 12345 transferred to medical insurance.
Pingtan: 0591-12345 transferred to medical insurance.