What is the meaning of outpatient co-ordination and how to reimburse it?

Medical insurance outpatient co-ordination refers to a kind of medical insurance treatment that the medical expenses incurred by the personnel who participate in the basic medical insurance for employees in accordance with the scope of medical insurance payment are reimbursed by the outpatient co-ordination fund according to a certain proportion.

The overall reimbursement procedure is as follows:

1, the insured person must show his citizen card and swipe it, and the outpatient department must inform the hospital of the type of treatment. For those who fail to show their card certificates or whose treatment types are unclear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance fund;

2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the category of treatment, according to the relevant requirements of the credit card to buy drugs, because of special circumstances by others to buy drugs, must show the insured and drug buyers' ID cards, and registered by the pharmacy;

3. The outpatient medical expenses such as drugs, laboratory tests, inspection and consumables incurred by the employees' medical insurance insured during outpatient treatment. Within the policy scope of medical insurance reimbursement within a natural year, and the accumulated deductible expenses of tertiary hospitals are within 300 yuan, it will be reimbursed according to the proportion of 60%.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant medical records, drug receipts, medical expense lists and other related materials;

3. Go to the social security department for reimbursement: submit relevant materials to the local social security department for medical insurance reimbursement;

4. Waiting for review: the social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

To sum up, the proportion of medical insurance reimbursement in different regions is different. Urban and rural residents who live in different places for a long time, urban and rural residents over 60 years old and women over 55 years old, urban and rural residents who work in different places, and accompanying students and children have registered for medical treatment in different places. The standard of hospitalization deductible at the place of registration is 400 yuan, 800 yuan, a first-class hospital, and 2000 yuan. The reimbursement ratio is implemented by local designated hospitals.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and 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.