How much can I be reimbursed for special diseases? Is there any reimbursement for hospitalization fo

Disease. Outpatient designated diseases, special diseases, and subsidized diseases are collectively referred to as specific diseases. The first two need to be submitted at the Liannan County People's Hospital first, and then submitted to the Social Security Bureau. The subsidized diseases are handled directly with the social security department.

Currently, there are 7 types of diseases designated for outpatient clinics.

1.Malignancy.

Chemoradiotherapy, liver cancer.

Postoperative antiviral**, breast cancer.

Prostate cancer postoperative endocrine**, drug targeting**.

2.Uremia.

Limit hemodialysis and abdominal dialysis.

3.Anti-rejection after kidney transplantation**.

4.Anti-rejection after liver transplantation**.

5.Postoperative anti-rejection of bone marrow transplantation**.

6.Haemophilia.

7.Thalassemia major or marine anemia.

Note: The reimbursement limit for designated diseases is based on the overall payment limit for hospitalization.

Generally, no. Unless the treatment of cerebrovascular sequelae cannot provide the recent muscle strength condition, the patient must be brought here. Those who can provide muscle strength recovery after half a year do not need to bring patients.

Section or Medical Affairs Section Business Chapter).

2.A recent one-inch smaller color photograph, regardless of the background color.

3.Identity card.

If the stent is placed for bypass, the surgical record or stent placement diagram or coronary angiography results should be provided; COPD.

Pulmonary function test reports are required; This is the most common information that is omitted. ）

When I arrive at Liannan County People's Hospital, which department should I go to?

First go to the medical insurance office of Liannan County People's Hospital, let the staff help sort out the information, and if the information is complete, you need to find the director of the relevant department to write the application form for review and signature, and then go to the medical insurance office to submit the information for registration, and the hospital will submit the information to the county social security bureau for review. If the audit is not passed, it will be notified!

How can I use the special disease certificate?

The amount paid for each condition is not necessarily the same (see above**). Suppose you have high blood pressure.

2,300 yuan a year for employees and 1,000 yuan for residents. If you use it up this year, you will only be reimbursed on January 1 next year!

In addition, the following aspects should be noted:

1.When prescribing medicine, the doctor will know that a special outpatient prescription is issued by showing the special disease certificate. Special diseases can be directly reimbursed by any designated medical institution within the scope of Qingyuan City.

If you go out of Qingyuan (such as Guangzhou) to see a special outpatient clinic, you must remember to make a list and bring the invoice back to our Liannan social security department for reimbursement.

2.Each disease of special diseases is prescribed a scope of medicine (secondary directory library), do not prescribe drugs that are not related to the disease to the prescription of special diseases, so that the drugs that are not in the secondary catalog library are prescribed at their own expense, remember!

3.If you have a malignant tumor and need radiotherapy and chemotherapy, you must handle it as soon as possible, and provide a radiotherapy and chemotherapy plan to the social security department.

4.Remember that if the insured person meets the requirements of more than two outpatient specific diseases at the same time, he can only enjoy the limit of the highest standard disease, and not the limit of two diseases at the same time.

Hospitalization can be reimbursed for special diseases, taking Beijing as an example.

After Beijing adjusts the filing process for special diseases, insured persons suffering from special diseases can complete the procedures such as declaration, filing, settlement, and treatment inquiry in a "one-stop" manner at the designated medical institutions selected by themselves. Insured persons who have completed the filing process for special diseases can enjoy the relevant reimbursement policies for special diseases to reduce the burden of outpatient medical treatment.

Insured persons suffering from special diseases should fill in the declaration form at the designated hospital for special diseases, sign it by the physician, and go through the filing procedures at the hospital medical insurance office with their social security card. After completing the filing, you can carry out ** in the hospital, and there is no need to go through the procedures with the unit and the handling agency.

When a staff member who is resettled in another place or stationed in another place for a long time chooses a designated hospital in another place for a special illness, he or she can go through the filing procedures with the medical insurance agency in the insured area with his social security card, diagnosis certificate and declaration form. If the insured person wants to change the designated hospital for special diseases due to his or her illness, he or she can settle the fees at the original designated hospital with his social security card and go through the cancellation procedures, and go through the filing procedures with his social security card at the newly selected designated hospital for special diseases the next day.

1. Reimbursement procedures for medical insurance for special diseases:

1. The applicant shall bring the information to the medical insurance center of the district where the insured unit is located; Flexible employees should directly submit the information to the medical insurance center of the district where they are enrolled. If the insured incurs medical treatment and drug purchase expenses in designated medical institutions within the jurisdiction, he or she shall directly settle with his social security card.

2. The medical expenses incurred by the insured in non-designated medical institutions or designated medical institutions outside the city shall be paid by the insured himself, and he or she can go to the social security institution for reimbursement with the prescribed materials.

2. The following information should be brought when reimbursement:

1. Original ID card or social security card;

2. The original certificate of disease diagnosis issued by the specialist doctor of the designated medical institution;

3. Original medical information such as outpatient medical records, examinations, and test result reports;

4. The original receipt of outpatient charges of the unified financial and taxation medical institutions;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment prescription issued by the doctor;

6. The original uniform invoice for the sale of tax commodities in designated pharmacies and the computer printed list;

7. If it is handled on behalf of the agent, the original ID card of the agent needs to be provided.

3. Reimbursement for special diseases.

1. Reimbursement ratio: The expenses of "special diseases" incurred in outpatient clinics are treated as hospitalizations and reimbursed according to the proportion of hospitalization, and can be accumulated with the expenses of ordinary hospitalization.

2. The settlement cycle of "special diseases" is 360 days, and the minimum payment line of 1,300 yuan is only charged once within 360 days (here is the Beijing standard), including the ordinary hospitalization in my designated medical institutions, and the maximum reimbursement limit is 300,000 yuan.

Extended Materials. Settlement Procedure.

1) Settlement procedures for inpatient and outpatient clinics for special diseases.

Before the 10th of each month, the designated medical institutions shall report the cost statement, hospitalization statement and relevant information of the discharged patients in the previous month to the medical insurance agency, and the medical insurance agency shall review and approve it as the basis for monthly pre-allocation and year-end accounts. The medical insurance agency pre-allocates the overall expenses of the previous month's inpatient and special disease outpatient clinics** every month.

Insured persons who have been identified as suffering from special diseases shall go to a designated medical institution designated by the labor and social security department to seek medical treatment and purchase medicines, and the medical expenses incurred shall be directly billed and settled immediately.

2) Emergency settlement procedures.

Insured persons due to emergency rescue to the city's non-designated medical institutions and other medical institutions hospitalized**, the medical expenses incurred, first paid by the individual or unit, after the end of the emergency rescue, with the hospital emergency medical records, examination, laboratory reports, invoices, detailed medical charges to the medical insurance agency according to the provisions of the reimbursement procedures.

Reimbursement ratio: 1) Compensation ratio of basic medical insurance:

Urban workers: 85% can be reimbursed, 2% for those aged 50, 4% for those aged 60, 89%, 6% for those aged 70, and 8% for those over 80 (including the number), and the same is the same for those who are 50 years old, and the reimbursement ratio is within 100%.

Urban and rural residents: low-grade payment and students and children: the proportion of reimbursement is 50%; 65% of the reimbursement rate for high-end contributors is available;

2) Reimbursement ratio of supplementary insurance:

Low: *38% - the amount of the payline for the current year's major illness.

High-end: *77% - the amount of the major illness payline for the current year.

To sum up, there are 21 types of diseases that can be reimbursed by outpatient special disease medical insurance, and the reimbursement ratio for different diseases is different for different insureds, and the maximum is not more than 100%.

Legal basis: Social Insurance Law of the People's Republic of China

Article 23.

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.

Legal analysis: 22 types of special arms are reimbursed for hospitalization, namely:

Radiotherapy, chemotherapy, and analgesia for malignancy**.

Dialysis in patients with renal failure**.

Anti-rejection after kidney, heart valve, hematopoietic stem cell, liver, lung transplantation**.

Diabetes type 1 and type 2.

Systemic lupus erythematosus.

Hypertension (stage 1 hypertension, intermediate-to-high-risk and very high-risk, stage 2 hypertension, stage 3 hypertension) coronary heart disease. Rheumatic valvular heart disease.

Sequelae of cerebrovascular accident (cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage), bronchial asthma, chronic bronchitis with obstructive emphysema, chronic cor pulmonale.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the standards of basic medical insurance drug lists, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

If you are insured for special disease outpatient services, the reimbursement ratio is: employee medical insurance, within one year of medical insurance, the starting line for special disease outpatient services is 400 yuan, and the reimbursement ratio of medical expenses that meet the specified ** range is the same as that of ordinary hospitalization. Medical insurance for urban and rural residents, within a medical insurance year, the starting line for outpatient services for special diseases is 400 yuan