1. Reimbursement scope: Medical insurance usually stipulates outpatient expenses that can be reimbursed, including registration fees, examination fees, treatment fees, surgery fees, medicine fees, etc. The specific scope of reimbursement will vary according to the region and medical insurance policy;
2. Reimbursement ratio: The medical insurance policy stipulates the reimbursement ratio of different items, which is generally above 50%. Some regions may provide a higher proportion, or even fully reimburse certain items. Some medical insurance policies also stipulate differential payment, that is, the expenses that exceed the reimbursement ratio are paid by the individual;
3. Reimbursement limit: The medical insurance policy may stipulate the annual or each outpatient treatment expense reimbursement limit. Once the limit is exceeded, the excess shall be borne by the individual;
4. Reimbursement process: employees need to bring relevant medical expense invoices and reimbursement materials in accordance with medical insurance policies and submit reimbursement applications through channels designated by medical insurance departments. The medical insurance department will review the application and reimburse the expenses according to the proportion stipulated by the policy.
The scope of medical insurance outpatient reimbursement usually includes the following items:
1. Registration fee: Medical insurance generally reimburses outpatient registration fee;
2. Inspection fee: the medical insurance will reimburse the outpatient doctor for the inspection fee;
3. Examination expenses: Medical insurance will reimburse outpatient examination expenses within a certain range, such as blood test, urine test and X-ray examination;
4. Treatment expenses: Medical insurance will reimburse outpatient treatment expenses, such as infusion, dressing change and physical therapy;
5, surgery costs: some simple outpatient surgery costs, such as peeling, tooth extraction. , it may also be within the scope of medical insurance reimbursement;
6. Drug expenses: Medical insurance will reimburse outpatient drug expenses within a certain range. It should be noted that the scope and proportion of drug reimbursement may be different in different regions and different medical insurance policies.
To sum up, the specific reimbursement regulations for employees' medical insurance clinics will be different due to different regions and medical insurance policies. It is recommended to consult the local medical insurance department, social security bureau or relevant institutions to obtain the most accurate and up-to-date information on reimbursement regulations for employees' medical insurance outpatient service.
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.