According to recent reports and news, the statement that the overall quota for employee outpatient services will be cleared at the end of December is wrong. The Hunan Provincial Medical Insurance Bureau said this was a misunderstanding of the medical insurance policy. In fact, the annual reimbursement amount of medical insurance refers to the insured person in oneCalendar yeardegree,MedicalFees can be made in accordance with the regulationsMedical insurance co-ordination**Maximum payout limit for reimbursement. Each new oneCalendar yeardegree to begin,Employee medical insuranceThe pooled annual reimbursement amount for general outpatient clinics will be updated according to the new statistics to ensure that the insured person can continue to enjoy adequate protection. In other words, after the end of 2023 and into 2024, the annual reimbursement amount of the insured person's outpatient pool will be updated according to the new statistics in 2024 and enter the new oneCalendar yeardegrees. Therefore, there is no "zero" reimbursement amount, "waste", "money refund if it is not used up", etc.
The outpatient reimbursement limit is only the maximum payment standard that the insured person can be reimbursed for outpatient visits during the insurance year, and not everyone must meet the maximum limit. This is just like the hospitalization reimbursement limit, and the hospitalization of insured employees is basicMedicalThe maximum payment limit of serious illness insurance is 650,000 yuan, which does not mean that each insured employee must be reimbursed 650,000 yuan per year, but when the insured employee is sick and hospitalized**, the cumulative maximum reimbursement amount of basic medical insurance and serious illness insurance in an insurance year is 650,000 yuan. The Hunan Provincial Medical Insurance Bureau emphasized that it is impossible and unnecessary for each person to reach the reimbursement amount of 650,000 yuan, and the same is true for the maximum outpatient reimbursement limit.
Therefore, when the insured person enjoys the outpatient reimbursement, he or she needs to have a doctor's prescription, and the drugs purchased must be included in the medical insurance catalogue before they can be reimbursed by medical insurance. Designated medical institutions shall not reduce or exempt patients' out-of-pocket expenses when carrying out outpatient reimbursement, and shall strictly check the identity information of the insured. In short, insured patients can only use the outpatient pooling quota if they have a genuine illness that requires medical treatment at a designated medical institution, and they need to pay a certain percentage of the cost out of pocket. The medical insurance department will conduct all-round supervision of the use of outpatient co-ordination** to prevent the abuse and waste of medical insurance**.
Employee medical insuranceOutpatient co-ordination is a good policy, but the insured should not blindly use the reimbursement amount, it must comply with the outpatient co-ordination policy, and need to pay a certain percentage of the cost out of pocket, and it is not allowed to be reimbursed without a diagnosed disease. Designated medical institutions and insured persons should jointly complyEmployee medical insuranceOutpatient co-ordination regulations. The Hunan Provincial Medical Insurance Bureau once again reminds that medical insurance** is the "medical money" and "life-saving money" used by all insured people, and do not use medical insurance in violation of regulations in order to pursue small bargains**. Insured persons should use medical insurance reasonably and legally** in order to better protect their health.