Q & A policies for ordinary outpatient clinics in Yantai City

1. Practice time for ordinary outpatient clinics?

Answer: The overall overall system of employees in our city will be implemented from July 1, 2022.

2. Which groups can enjoy ordinary outpatient clinics in our city?

Answer: Those who participate in the medical insurance of our city and enjoy normal treatment (including flexible employment) can enjoy. Cadres of retired cadres, levels of disabled first to sixth -level disabled, and pre -founding old workers' outpatient protection benefits are implemented in accordance with the original policy.

3. Which expenses can be included in ordinary outpatient clinics of employees?

Answer: Insured people occur in the medical expenses of outpatient medical institutions in ordinary outpatient medical institutions. - "Medical Insurance Services" - "Office Hall" - "I want to inquire" - "Medical Insurance Catalog" query or log in to Yantai Municipal Medical Security Bureau's official website to click "Public Service" - "Personal Service" - "Service Catalog" - "Medical Insurance Catalog ") The costs of relevant regulations can be included in the general outpatient clinics of employees in accordance with regulations.

4. What is the standard for the general outpatient clinic of employees? What are the cumulative calculations of the starting payment standard?

Answer: During a natural year, the standard payment standard for the first -level and below designated medical institutions is 500 yuan, level 2 and above.

The insured person was visited in the first -level hospital. At that time, the general outpatient clinic met the cost of the medical insurance policy and reached a total of 500 yuan for the first -level hospital payment standard, and the general outpatient medical expenses that met the medical insurance regulations were included in the reimbursement. At that time, the cost of the general outpatient clinic in accordance with the medical insurance policy reached a total of 800 yuan for the starting payment standard of second- and third -level hospitals, and the general outpatient medical expenses that complied with the medical insurance regulations were included in the reimbursement. If the insured will change the designated medical institution within the year, the accumulated payment standard does not exceed 800 yuan.

5. What is the reimbursement ratio of ordinary outpatient clinics?

Answer: The employee incurred in the designated medical institution is in line with the medical insurance policy and stipulates the general outpatient medical expenses. The payment ratio of the first -level and below designated medical institutions is 70%, the paid ratio of the second -level designated medical institution is 60%, and the proportion of the third -level designated medical institution pays percentage. For 50%, retirees increased 5 percentage points on the basis of the above.

6. What is the payment limit for the overall payment of ordinary outpatient clinics?

Answer: During a natural year, the highest annual payment limit for the medical expenses of ordinary outpatient clinics is 1,800 yuan. The maximum payment limit in 2022 was 900 yuan.

7. Can ordinary outpatient medical expenses occur in which medical institutions occur?

Answer: The general outpatient clinic of employees is planned for a fixed -point medical treatment. The insured person's prescribed medical insurance policy prescribed by medical insurance policies can be reimbursed in accordance with the medical insurance policy. Participating employees can pay attention to the WeChat public account "Yantai Medical Security Bureau" click "WeChat" - "Practice Points for the Ordinary Outpatient Clinic" or logged in to Yantai Medical Security Bureau's official website to click "Notice Announcement" to inquire about the list of designated medical institutions of ordinary outpatient clinics in the city Essence

The medical expenses incurred in the designated medical institutions in non -Putong outpatient clinics are not reimbursed.

8. Do employees need to sign a contract with medical institutions?

Answer: No need. When the insured employees are for the first time, the medical insurance information system is automatically signed. When the designated medical institution signed by the contract cannot meet the needs of the diagnosis and treatment, the employee can choose the eligible ordinary outpatient designated medical institution for treatment without signing a separate contract.

9. How to reimburse the cost of ordinary outpatient clinics?

Answer: The insured person in the city's ordinary outpatient medical institutions for medical treatment for medical institutions will be settled in real time. I only need to pay the individual in the general outpatient fee. Participating employees can open medical insurance electronic vouchers, see a doctor to buy medicine and scan the code to pay, without having to hold social security cards or ID cards.

10. Can employees who enjoy the treatment of slow special diseases can enjoy ordinary outpatient treatment?

Answer: Yes. During the insured person to enjoy the slow special disease of outpatient clinics, the general outpatient medical expenses that meet the medical insurance policy can enjoy the general outpatient treatment treatment.

11. Enjoy the insured employees who enjoy the treatment of slow special diseases. At the same time, how to reimburse the medical expenses of general outpatient and outpatient clinic for employees?

Answer: (1) The insured should seek medical treatment at a designated medical institution in the general outpatient clinic of employees.

When the insured, the insured should take the initiative to inform the doctors' outpatient guarantee categories. The doctors should open the prescription of slow specialties and ordinary outpatient diseases. When paying, the insured employees only need to pay the personal burden of different outpatient guarantee treatment categories.

(2) The insured should seek medical treatment at a designated medical institution in the general outpatient clinic of employees.

① If the insurer only occurs for general outpatient medical expenses or ordinary outpatient medical expenses and the cost of slow special diseases for outpatient clinics, the general outpatient medical expenses of employees can be settled in the medical institution in the medical institution in the medical institution.

② If the insurer occurs at the same time, the medical expenses of the general outpatient and outpatient clinic at the same time and the medical expenses of the outpatient clinic are in a prescription, the insured must pay the medical expenses in full and print the invoice. Reimbursement of medical institutions on behalf of medical institutions. At the same time, the insured should sign the "commitment" that the insured should not be repeatedly enjoyed during the first year.

12. What proportion of the general outpatient clinic for employees through outpatient medical institutions is reimbursed through outpatient medical institutions?

Answer: The insured goes to his designated outpatient slow special disease medical institution on behalf of the employee's general outpatient medical expenses to be reimbursed at the hospital -level payment ratio. To. The expenses of slow special diseases for outpatients are still implemented in accordance with the original policy. 13. Can the insured during the hospitalization and enjoying long -term care insurance medical treatment, can I enjoy the general outpatient treatment of employees?

Answer: Don't enjoy. Because the insured has a corresponding guarantee policy during the hospitalization and enjoying long -term care insurance specialty, it is not enjoyed by the general outpatient clinic for overall treatment.

14. Can the insured person be used for medical treatment at different places to enjoy the general outpatient treatment of employees?

Answer: If the insured person has handled long -term residence filing in different places, the medical insurance costs that meet the medical insurance policy in the designated medical insurance institutions in the residential place are implemented, and the general outpatient treatment policy of designated medical institutions at the same level in the city is implemented.

Temporary goal to the medical insurance policy that is temporarily going to go out for medical treatment (no filing in the province, and the required filing of the province) is in line with the medical insurance policy. After the individual pays 10%, the general outpatient treatment policy of designated medical institutions at the same level in our city will be implemented.

15. The insured who has been treated in a different place to see a medical treatment for outpatient clinics. How to reimburse the medical expenses of general outpatient and outpatient slow special diseases at the same time?

Answer: When the insured person, the insured should take the initiative to tell the doctor's outpatient guarantee category, and the doctors will open the prescription of slow specialties and ordinary outpatient diseases, respectively. The insured persons will pay the network settlement according to different outpatient guarantee treatment categories.

16. How to reimburse ordinary outpatient costs of employees who have not been settled in different places?

Answer: If the insured person is in line with the medical insurance policy, the medical insurance policy stipulates that the general outpatient medical expenses have not been settled, and the person or the agent holds valid documents, invoices, and expenses. According to reimbursement, the general outpatient expenses incurred in different places are reimbursed according to the relevant policies of medical treatment and the general outpatient treatment policy of local hospitals.

17. What behaviors should be avoided for employees?

Answer: Ordinary outpatient clinics should seek medical treatment for medical treatment, and must not be replaced by names; they must not be used by borrowing or transferring their social security cards to others; they must not forge or use other people's social security cards to seek medical treatment; , Check the inspection report and other medical documents; you must not use the opportunity to enjoy the treatment of ordinary outpatient treatment for employees to resold drugs, medical devices or medical consumables, accept cash, physical or other illegal benefits.

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