Anhui province medical insurance outpatient reimbursement new policy

Anhui Province urban health insurance reimbursement scope:

1, outpatient reimbursement:

(1) village health clinic and village center health clinic visit reimbursement of 60%, each visit to the prescription drug fee limit of 10 yuan, the health center doctor temporary rehydration of prescription drug fee limit of 50 yuan.

(2) Township health centers will be reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.

(3) Secondary hospitals will be reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.

(4) Tertiary hospitals will reimburse 20% of the cost, with a limit of RMB 50 for each examination and operation and RMB 200 for prescription drugs.

(5) Chinese medicine invoices with prescription attached are limited to RMB 1 yuan per sticker.

(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.

2. Hospitalization Compensation

(1) Reimbursement Scope:

A. Pharmaceutical Fees: Auxiliary Examinations: Limit of 200 RMB for each examination fee such as EKG, X-ray fluoroscopy, radiography, laboratory tests, physiotherapy, acupuncture, CT, MR*** vibration, etc.; Surgical Fees (with reference to the national standard, reimbursement for fees in excess of 1,000 RMB will be made in accordance with the limit of 1,000 RMB).

B, the elderly over 60 years of age hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.

(2) Reimbursement rate: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.

3. Compensation for major illnesses

Reimbursement ratio list:

(1)Town risk fund compensation: All hospitalized patients who participate in the rural cooperative medical insurance one-time or annual cumulative total of the reportable medical expenses exceeding 5,000 yuan or more segmented compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%.

(2) The annual limit of compensation for township-level cooperative medical care inpatient and outpatient blood dialysis for uremia, and outpatient radiotherapy and chemotherapy for oncology is 11,000 yuan.

Anhui province health insurance outpatient reimbursement new policy:

(1) active employees: the abolition of the proportion of the enterprise part of the transfer, retaining only the individual contribution part.

(2) Retirees: flat-rate allocation, the standard in 2022 will be 150 yuan/month. That is to say: after the adjustment, enterprise employees and retirees, the monthly money transferred to the personal account is reduced.

New scope of use: on the basis of the original, three new categories of people: spouses, parents, children. That is to say: after the adjustment, the individual health insurance account can be used to pay: myself, my spouse, parents, children in the designated medical institutions incurred medical expenses.

The outpatient reimbursement rate has been changed, and the outpatient reimbursement rate for active employees: starting from 50%. Outpatient reimbursement rate for retirees: increased by 5%.

It should be noted that, in order to connect with the amount credited to the personal account, there is also a threshold fee and a ceiling line for outpatient reimbursement. The threshold fee for outpatient reimbursement is set at about 3% of the per capita disposable income of urban and rural residents in the previous year. The outpatient reimbursement ceiling is set at approximately 5% of the per capita disposable income of urban and rural residents in the previous year. Specifically, in a natural year (January-December), if the expenses incurred in the general outpatient clinic of a designated hospital or the expenses incurred in the designated designated retail pharmacy for purchasing medicines in accordance with the outpatient prescription exceed about 3% of the per capita disposable income of urban and rural residents of the previous year in the local area, the medical insurance fund will pay part of the expenses in accordance with the stipulated proportion, and the individual will pay part of the expenses out of his own pocket. However, there is an upper limit to the amount that can be paid, which cannot exceed 5% of the local urban and rural residents' per capita disposable income in the previous year in a natural year.

Legal basis:

"Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers"

Article 2: The following units in the cities and towns of this province and their employees must participate in basic medical insurance in accordance with these regulations:

(1) Enterprises and their employees

(2) Institutions, institutions, intermediary organizations, and social organizations, private non-enterprise units and their employees;

(3) Employing units belonging to the army and their employees without military status. These Regulations shall apply to the retirees of the above units.