First, outpatient co-ordination.
1, general outpatient co-ordination
Within an insurance year, the insured's general outpatient medical expenses that meet the requirements shall be paid by the individual first, and the first-visit medical institution shall pay 50% of the expenses from 200 yuan to 1500 yuan, and 40% of the expenses shall be paid by the medical insurance fund after the referral formalities are handled according to regulations.
2. Outpatient specific diseases
If the insured suffers from serious mental illness, epilepsy and mental disorder, after confirmation by the Municipal Medical Insurance Center, the residents' medical insurance fund will pay 85% to "minor residents" and "college students" and 75% to other personnel for the expenses incurred by using psychotropic drugs in outpatient clinics within 200 yuan every month; Residents' medical insurance fund pays 85% of the expenses for cataract phacoemulsification and intraocular lens implantation within 3,000 yuan for "minor residents" and "college students", and other personnel pay 75%.
3, outpatient illness
The qifubiaozhun for outpatient serious illness expense settlement is 800 yuan/year. The expenses below Qifubiaozhun shall be borne by the individual, and the expenses exceeding Qifubiaozhun shall be paid according to the hospitalization settlement method. At the same time, quota management is implemented: the quota standard of anti-rejection treatment after organ transplantation is 100000 yuan/year in the first year, 70000 yuan/year in the second year and 50000 yuan/year in the third year; The limit standard of hemophilia treatment is 8000 yuan/year; The treatment limit standard of aplastic anemia is 15000 yuan/year.
Second, co-ordinate hospitalization.
For patients in tertiary medical institutions, the minimum qifubiaozhun for "minor residents" and "college students" is 400 yuan/time, 85% of the minimum qifubiaozhun and the maximum amount is paid by the residents' medical insurance fund, and the minimum qifubiaozhun for other personnel is 800 yuan/time, and 75% of the minimum qifubiaozhun and the maximum amount is paid by the residents' medical insurance fund; For medical treatment in primary and secondary medical institutions, the minimum threshold for "minor residents" and "college students" is 200 yuan/time, 95% of the minimum threshold is paid by the residents' medical insurance fund, and the minimum threshold for other personnel is 400 yuan/time, and 85% of the minimum threshold is paid by the residents' medical insurance fund.
Legal basis:
Constitution of the people's Republic of China
Article 45 The people of China and citizens of China have the right to get material help from the state and society in case of old age, illness or incapacity to work. The state develops social insurance, social relief and medical and health services that citizens need to enjoy these rights.