How to deal with chronic disease medical insurance reimbursement?

A person's life, birth, old age, sickness and death must be something to be experienced. The probability of suffering from a major disease in a person's life is as high as 72%, and for some patients with chronic diseases, medical expenses must be a big burden. First of all, we need to know what a chronic disease is.

It is not as good as high blood pressure, coronary heart disease, diabetes and other diseasesIt can be regarded as a chronic disease. <>

When a patient suffers from a chronic disease, he or she must first go through the procedures for applying for a chronic disease in an outpatient clinic, fill in the application form according to his application, and bring it to the county medical insurance center with the diagnosis certificate materials of the second-level hospital or above and the report of the relevant examination, and then apply for the chronic disease certificate after professional appraisal and review. However, each person can apply for up to 3 types of chronic diseases, and they will be approved twice a year. <>

The second step is to report the diagnosis certificate materials above the second level to the social security center, and after the appraisal and review of the expert committee, the chronic disease certificate will be processed. The expert committee will hold the appraisal of chronic diseases once a quarter, and the cost of the appraisal shall be borne by the individual or the unit.

The third step is for the patient to see a doctor in the outpatient department of a specially designated hospital and purchase medicines. <>

Fourth, the patient should go to the social security center to reimburse the medical expenses for chronic diseases within the specified time, and at the same time bring prescriptions, invoices, chronic disease certificates, medical records and various examination reports and file them.

I think that the medical expenses of patients with chronic diseases are definitely a lot of expenses, and I think it is a good thing for the national team to reimburse the medical insurance for patients with chronic diseases, and it can greatly reduce the financial pressure of patients with chronic diseases. After all, no one wants to get sick, but when the disease comes, we must not be afraid, we must defeat the disease, so that we can have a healthy body again. When we have a healthy body, we will have a happier and happier life.

1. Information is required to declare chronic diseases. Step 2: The Municipal Medical Insurance Bureau and the handling windows of each district bureau shall conduct a preliminary review of the materials declared by the chronic disease personnel.

Step 3: The Municipal Medical Insurance Bureau will organize the verification of the chronic disease declaration materials. Step 4:

The Municipal Medical Insurance Bureau classifies the diseases according to the types of diseases participating in the examination, and contacts the physical examination hospital. Step 5: The Municipal Medical Insurance Bureau and each district bureau shall notify the persons with chronic diseases within their jurisdiction to participate in the physical examination.

Step 6: Those who participate in the physical examination for chronic diseases should designate a hospital to participate in the physical examination on time according to the time notified by the municipal or district medical insurance bureau. Step 7:

The Municipal Medical Insurance Bureau organizes experts to identify chronic diseases. Step 8: The Municipal Medical Insurance Bureau will enter the relevant information such as the level and type of disease into the system for the chronic patients who have been recognized by experts to generate the chronic disease card number.

and make a chronic disease card.

If the cash settlement reaches a certain amount, you can apply for serious illness medical insurance, and go to the local medical insurance bureau to declare serious illness medical insurance reimbursement with the settlement invoice.

Reimbursement process for chronic diseases under medical insurance: Within the time limit for the declaration of chronic diseases stipulated by the local government, the required materials (medical certificate, copy of inpatient medical record and copy of ID card) can be submitted to the medical insurance center to apply for reimbursement.

Does the chronic disease medical insurance have to prescribe 800 yuan of medicine before it can be reimbursed?

1. The patient shall apply to the Social Security Center and fill in the formal application form.

2. Report the diagnosis certificate materials of the second-level hospital or above to the social security center, and handle the chronic disease certificate after being appraised and reviewed by the expert committee. The expert committee conducts the appraisal of chronic diseases once a quarter, and the cost of the appraisal is borne by the individual or unit.

3. Patients should see a doctor and purchase medicine in the outpatient department of the designated hospital.

4. Within the specified time, go to the social security center to reimburse the medical expenses for chronic diseases, and at the same time file the "List of Outpatient Medical Expenses for Chronic Diseases" together with prescriptions, invoices, chronic disease certificates, medical records, and various examination reports. It is important to note that when applying for chronic disease reimbursement, each person can claim up to three chronic diseases.

To sum up, we can know that chronic diseases are a kind of disease that must be long-term, so medical insurance has special provisions for chronic diseases, first of all, before reimbursement, we must submit an appraisal report and a confirmation of chronic diseases, otherwise we will not be able to talk about reimbursement, and the medical insurance can accumulate 3,000 yuan, and can only declare 3 chronic diseases at most, which cannot exceed the specified standards.

The reimbursement policy for chronic diseases under medical insurance is as follows:

1. The outpatient treatment of insured patients in designated medical institutions in this city, or the outpatient designated chronic disease corresponding to the outpatient treatment in selected non-local medical institutions according to the regulations, shall be paid by the employee social medical insurance according to the standard of 85% of the primary medical institutions and 65% of other medical institutions;

2. The maximum payment limit for the corresponding specialty drug fees and general diagnosis and treatment fees for the outpatient designated chronic diseases of insured patients is 200 yuan per person per month for each disease. The maximum monthly payment limit standard of the overall social medical insurance for employees is valid in the current month, and it is not rolled over or cumulative;

3. Insured patients with a variety of outpatient designated chronic diseases can choose up to 3 of them to enjoy the corresponding outpatient designated chronic disease medical insurance treatment. Once the disease is selected, it will not be changed within one year. Insured patients are not allowed to enjoy outpatient designated chronic disease medical insurance benefits during their illness and hospitalization;

4. The social medical insurance for employees shall pay the corresponding specialist drug fees for the outpatient designated chronic diseases of the insured patients or shall comply with the list of designated chronic disease drugs for the outpatient clinics of the social medical insurance of this city. The list of specific outpatient designated chronic disease drugs is published on the portal of the Municipal Human Resources and Social Security Bureau**.

Medical insurance also has two major functions of insurance, risk transfer and compensation transfer. That is, the economic loss caused by the risk of disease in the individual is apportioned to all members who are threatened by the same risk, and the economic loss caused by the disease is compensated by the centralized medical insurance**.

Legal basisSocial Insurance Law of the People's Republic of China

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Photographing traditional Chinese medicine outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

The reimbursement policy for chronic outpatient medical insurance is as follows:

1. Minimum payment standard for chronic diseases, 300 yuan;

2. The reimbursement ratio for chronic diseases is 50% for adult residents who pay according to the low-grade standard; The reimbursement rate for minor residents and adult residents who pay premiums at the high-end standard is 60%;

3. There is no threshold for reimbursement of outpatient expenses for radiotherapy and chemotherapy for malignant tumors, uremia dialysis**, and anti-rejection drugs after tissue and organ transplantation, and the reimbursement ratio for adult residents who pay according to low-grade standards is 70%, and the reimbursement ratio for minor residents and adult residents who pay according to high-end standards is 80%;

4. The annual reimbursement limit for taking anti-rejection drugs after uremia dialysis** and tissue and organ transplantation is 60,000 yuan for adult residents who pay according to the low-grade standard. The limit for juvenile residents and adult residents who pay premiums according to the high-end standard is 80,000 yuan.

The full name of chronic disease is chronic non-communicable disease, which does not refer to a specific disease, but is a general term for a type of disease with insidious onset, long course of disease and prolonged disease, lack of accurate biological evidence of infectious ruttan, complex, and some diseases that have not yet been fully confirmed. Common chronic diseases mainly include cardiovascular and cerebrovascular diseases, cancer, diabetes, chronic respiratory diseases, and central cerebrovascular diseases include hypertension, stroke and coronary heart disease. The harm of chronic diseases is mainly caused by damage to important organs such as the brain, heart, kidneys, etc., which is easy to cause disability, affect labor ability and quality of life, and the medical expenses are extremely expensive, increasing the economic burden of society and families.

Legal basis

Article 2 of the Social Insurance Law of the People's Republic of China The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State. Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance ** payment.

Legal analysis: daily patients should go to the designated hospitals and pharmacies of the municipal medical insurance for treatment or purchase of drugs, and the patients should keep the relevant invoices, prescriptions, inspection and laboratory tests and other relevant information of the year, and hand them over to the central manager at the end of the year to go through the relevant procedures of the municipal medical insurance. For people with chronic diseases, it is a long-term process, chronic diseases are different from the consumption of major diseases, and the cost of chronic diseases is accumulated over time.

The medical insurance policy has long stipulated the reimbursement of chronic diseases, and the chronic disease confirmation letter must be applied for before reimbursement.

Legal basis: Article 23 of the Social Insurance Law of the People's Republic of China Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

Article 24 of the Social Insurance Law of the People's Republic of China The State shall establish and improve a new type of rural cooperative medical system.

The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

Article 25 of the Social Insurance Law of the People's Republic of China The State shall establish and improve the basic medical insurance system for urban residents.

The basic medical insurance for urban residents implements a combination of individual payment and subsidy.

Those who enjoy the minimum living guarantee, the disabled who have lost the ability to work, the elderly over the age of 60 and minors from low-income families, etc., will be subsidized by **.

Article 26 of the Social Insurance Law of the People's Republic of China The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Answer: In the "Insurance Law" to apply for chronic disease medical insurance, first of all, the disease you suffer from is a disease in the list of chronic diseases, and you meet the conditions for handling chronic diseases, and then you must have a copy of the inpatient medical record of the disease in the hospital in the past 2 years, and the medical record must have the relevant examination results, diagnosis, etc. After meeting the above conditions, you can go to the local social security bureau or medical insurance office to get the chronic disease application form, go to the hospital to ask the doctor to fill in the chronic disease application form, and issue a diagnosis certificate at the same time, some places also need a copy of the ID card and medical guarantee, according to the employee medical insurance or resident medical insurance, all the information will be submitted to the medical insurance department of the unit or the local social security bureau and other departments for approval, and after the completion of the processing, you can prescribe drugs and check in the outpatient department of the designated hospital to enjoy the reimbursement policy.