In 2024, the outpatient reimbursement standards in Hubei Province vary depending on different types of insurance and medical institutions. Here are the details:
- Employee Medical Insurance
- Outpatient Coordination for General Illnesses
- Deductible: For both active employees and retirees, the deductible is 0 yuan.
- Reimbursement Ratio:
- When seeing a doctor in a first - level medical institution (including community health service institutions and township health centers), active employees can be reimbursed 85% by the co - ordination fund, and retirees 90%.
- In a second - level medical institution, active employees are reimbursed 65%, and retirees 75%.
- In a third - level medical institution, active employees are reimbursed 55%, and retirees 65%. The reimbursement ratio for outpatient services at designated retail pharmacies is the same as that of first - level medical institutions.
- Annual Payment Limit: The annual maximum payment limit for the general outpatient co - ordination fund is 3500 yuan for active employees and 4500 yuan for retirees.
- Outpatient Chronic and Special Diseases
- Disease Types: There are 37 types of outpatient chronic and special diseases, including malignant tumor outpatient treatment, chronic renal failure dialysis, organ transplantation anti - rejection treatment, etc.
- Reimbursement Ratio: For outpatient special diseases, the reimbursement ratio for active employees is 89% and for retirees is 91.2%. For outpatient chronic diseases, the reimbursement ratio for active employees is 80% and for retirees is 85%. When using Class B drugs and medical service items in the basic medical insurance catalog, individuals first pay 10%, and the remaining amount is reimbursed according to the regulations.
- Annual Payment Limit: For outpatient chronic diseases, the payment limit varies according to different disease types, ranging from 5000 yuan to 25000 yuan. When applying for two or more outpatient chronic disease types, on the basis of the highest - level chronic disease limit, the cumulative payment limit for chronic diseases increases by 50% of the limit standard for each additional disease type. The reimbursement amount for a single disease type does not exceed the annual payment limit for that disease type, and the cumulative amount does not exceed the annual maximum payment limit of basic medical insurance. For outpatient special diseases, it is calculated together with general outpatient and inpatient reimbursement benefits and does not exceed the annual maximum payment limit of basic medical insurance.
- Resident Medical Insurance
- Outpatient Coordination for General Illnesses
- Deductible: For urban and rural residents' medical insurance participants (except college students), there is no deductible when seeing a doctor in community health service centers (unranked), township health centers, community health service stations, and village clinics. The annual cumulative deductible for other medical institutions is 200 yuan.
- Reimbursement Ratio: The reimbursement ratio of the resident medical insurance fund is 50%.
- Annual Payment Limit: The annual payment limit is 400 yuan.
- Outpatient Chronic and Special Diseases
- Disease Types: The same 37 types as for employee medical insurance.
- Reimbursement Ratio: For ordinary residents, the reimbursement ratio is 70%, and for college students, it is 90%. When using Class B drugs and medical service items in the basic medical insurance catalog, individuals first pay 10%, and the remaining amount is reimbursed according to the regulations.
- Annual Payment Limit: Similar to that of employee medical insurance, for outpatient chronic diseases, the payment limit varies according to different disease types, ranging from 4000 yuan to 20000 yuan. When applying for two or more outpatient chronic disease types, on the basis of the highest - level chronic disease limit, the cumulative payment limit for chronic diseases increases by 50% of the limit standard for each additional disease type. The reimbursement amount for a single disease type does not exceed the annual payment limit for that disease type, and the cumulative amount does not exceed the annual maximum payment limit of basic medical insurance. For outpatient special diseases, it is calculated together with general outpatient and inpatient reimbursement benefits and does not exceed the annual maximum payment limit of basic medical insurance.
- Outpatient Medication for Hypertension and Diabetes
- For "two - disease" (hypertension and diabetes) patients who are not covered by the outpatient chronic disease guarantee but need to take antihypertensive and hypoglycemic drugs, the antihypertensive and hypoglycemic drugs are included in the outpatient guarantee scope.
- When seeing a doctor and taking medicine at grassroots designated medical and health institutions, the reimbursement ratio within the policy - compliant scope is not less than 50%, and the reimbursement limit is increased by a certain amount according to the disease condition on the basis of the general outpatient service.
- "Dual - Channel" and "Separate Payment" Drugs
- Hubei residents can purchase "separate payment" drugs through two channels: hospitals and pharmacies. There is no deductible, and the reimbursement ratio for medical expenses within the policy - compliant scope is not less than 50%. The maximum reimbursement amount is the same as that for inpatient services, with an average of about 130,000 yuan.
- For offline drug purchases, insured patients in Hubei can purchase "dual - channel" and "separate payment" drugs at "dual - channel" designated retail pharmacies with an external prescription issued by a designated medical institution, and the medical insurance will reimburse according to regulations.
- Maternity Medical Expenses
- Maternity medical expense protection has been extended from employees to residents. All basic medical insurance participants in Hubei can enjoy maternity medical expense benefits.
- The antenatal examination expenses of residents participating in medical insurance can be reimbursed through general outpatient services. The hospitalization delivery payment has been increased from the previous fixed - amount reimbursement of 800 - 1500 yuan to a maximum reimbursement of about 130,000 yuan. The policy - compliant medical expenses for 8 assisted reproductive items such as "egg retrieval" incurred in outpatient services can be reimbursed at 65%, and do not occupy the general outpatient quota.
In general, Hubei's 2024 outpatient reimbursement standards aim to provide more comprehensive and affordable medical security for different groups of people, covering various aspects such as general outpatient services, chronic and special diseases, and specific types of medical expenses. When seeking medical treatment, it is recommended that insured individuals understand the relevant regulations clearly to ensure smooth reimbursement of medical expenses.