贵州门诊医保报销额度是多少

有家健康网 2025-05-07阅读量：8671

In 2025, the outpatient reimbursement amount of Guizhou medical insurance varies according to different situations. For general outpatient services, the annual maximum reimbursement is 500 - 600 yuan; for outpatient services related to "two diseases" (hypertension and diabetes), the maximum reimbursement for hypertension is 800 yuan, for diabetes is 1200 yuan, and for those with both diseases, the annual maximum reimbursement is 2000 yuan; for prenatal check - ups, the reimbursement amount within the pregnancy cycle is 600 yuan, which can be combined with the general outpatient co - ordination amount for reimbursement, with a maximum reimbursement of 1100 - 1200 yuan.

1. General Outpatient Reimbursement Details

• Reimbursement Ratio:

• At village clinics (community health service stations), the reimbursement ratio is 90%. For example, if you spend 100 yuan on eligible medical expenses at a village clinic, you can be reimbursed 90 yuan.

• At township health centers (community health service centers) and first - level and undetermined - level medical institutions, the reimbursement ratio is 85%. Suppose you have 200 yuan of eligible expenses at a township health center, then you can get 200×85% = 170 yuan reimbursed.

• At second - level medical institutions, the reimbursement ratio is 60%. If the eligible expenses are 300 yuan at a second - level hospital, the reimbursement amount is 300×60% = 180 yuan.

• Annual Reimbursement Limit: The annual maximum reimbursement for general outpatient services is 500 - 600 yuan. Once this limit is reached within a year, no more reimbursement will be provided for general outpatient expenses in that year.

2. "Two Diseases" (Hypertension and Diabetes) Outpatient Reimbursement

• Reimbursement Ratio:

• At first - level and below medical institutions (including township health centers, community health service centers, village clinics, and community health service stations), the reimbursement ratio is 90%. For instance, if a diabetic patient has 500 yuan of eligible expenses for outpatient treatment at a village clinic, 500×90% = 450 yuan can be reimbursed.

• At second - level medical institutions, the reimbursement ratio is 80%. If the eligible expenses are 400 yuan at a second - level hospital, the reimbursement amount is 400×80% = 320 yuan.

• At third - level medical institutions, the reimbursement ratio is 70%.

• Annual Reimbursement Limit: For hypertension, the annual maximum reimbursement is 800 yuan; for diabetes, it is 1200 yuan. If a patient has both hypertension and diabetes, the annual maximum reimbursement is 2000 yuan.

3. Prenatal Check - up Reimbursement

• Reimbursement Ratio: At township health centers (community health service centers), the reimbursement ratio is 85%; at second - level hospitals, it is 60%; at third - level hospitals, it is 50%.

• Reimbursement Amount: The reimbursement amount for prenatal check - ups within the pregnancy cycle is 600 yuan. This amount can be combined with the general outpatient co - ordination amount. So, in total, the maximum reimbursement can reach 1100 - 1200 yuan.

In general, the outpatient reimbursement amount of Guizhou medical insurance in 2025 has clear regulations for different situations such as general outpatient services, "two diseases" outpatient services, and prenatal check - ups. When seeking medical treatment, it is recommended that insured persons understand relevant policies in advance, choose the appropriate medical institutions, and keep relevant receipts and certificates to ensure smooth reimbursement.