What are the special diseases in medical insurance, and what are the special diseases in medical ins

According to the regulations, there are the following 19 special diseases in the medical insurance:

Malignant tumors, chronic heart failure, chronic respiratory failure, chronic renal failure, chronic liver failure, severe Alzheimer's disease, cerebrovascular accident, hypertension, diabetes, chronic viral hepatitis, hemophilia, systemic lupus erythematosus, Parkinson's disease, chronic aplastic anemia, severe mental disorders, tuberculosis, childhood autism, complete growth hormone deficiency, anti-rejection** after tissue and organ transplantation, etc., a total of 19 diseases.

Extended Materials. Social security declaration materials:

1. In order to reduce the burden of patients with special diseases, the social security department has set up special disease treatment for them, and the medical insurance treatment is equivalent to hospitalization due to the expenses incurred in outpatient treatment of special diseases, and the burden on patients will be reduced a lot.

2. When applying for special disease treatment, patients need to bring the special disease approval form filled in and signed by the specialist doctors and directors of secondary and above medical institutions (you can consult the medical insurance department of the hospital where you are treated), the original or photocopy of the medical treatment materials (discharge records or medical records) issued by the secondary and above medical institutions, and the original or photocopy of the medical examination report (pathology report or imaging examination report or laboratory test report) issued by the secondary medical institution or above ( If the medical examination report cannot confirm the diagnosis of the disease, three documents including the diagnosis certificate must be provided to confirm the diagnosis.

3. The insured can go to the office hall of the social security agency at all levels in the city to declare. Those who have passed the review will be recognized on the spot, and the "Medical Record of Special Diseases" will be issued and they will enjoy the treatment of special diseases.

Facts**Special Diseases - Encyclopedia">Special Diseases - Encyclopedia).

Scope of disease: name of disease and review and identification criteria.

1) Outpatient chemoradiotherapy for malignant tumors.

Patients with malignant tumors with clear clinical diagnosis and auxiliary diagnosis basis such as CT report and pathological examination report.

2) Outpatient hemodialysis in the uremia phase of chronic renal failure: patients with clinical diagnosis of chronic renal failure, with symptoms such as oliguria, anuria, pulmonary edema, pericardial effusion, etc., laboratory examination indicators: blood urea nitrogen, blood creatinine, endogenous creatinine clearance rate 5-10ml min, serum potassium; Serum creatinine in diabetic patients with chronic renal failure over 60 years old is 528umol l, and the endogenous creatinine clearance rate is 15ml min.

3) Taking anti-rejection drugs after organ transplantation: After kidney transplantation, hematopoietic stem cell transplantation, heart, liver, lung, pancreas and other organ transplantation, long-term outpatient use of anti-rejection drugs, including hormone drugs and immunosuppressants.

Legal analysis: According to the regulations, there are the following 19 special diseases in the medical insurance: tuberculosis, childhood autism, complete growth hormone deficiency, malignant tumors, chronic heart failure, chronic respiratory failure, chronic renal failure, chronic liver failure, severe Alzheimer's disease, Parkinson's disease, chronic aplastic anemia, chronic viral hepatitis, hemophilia, systemic lupus erythematosus, cerebrovascular accident, hypertension, diabetes, severe mental disorders, anti-rejection after tissue and organ transplantation, etc.

Legal basis: "Regulations on the Administration of Medical Institutions" Article 35 Medical establishments shall handle the special diagnosis and treatment of patients with infectious diseases, mental illness, occupational diseases, etc., in accordance with the provisions of relevant national laws and regulations.

There are 19 types of special diseases in the medical insurance: tuberculosis, childhood autism, complete growth hormone deficiency, malignant tumors, chronic heart failure, chronic respiratory failure, chronic renal failure, chronic liver failure, severe Alzheimer's disease, Parkinson's disease, chronic aplastic anemia, chronic viral hepatitis, hemophilia, systemic lupus erythematosus, cerebrovascular accident, hypertension, diabetes, severe mental disorders, anti-rejection after tissue and organ transplantation**, etc.

Regulations on the Administration of Medical Institutions

Article 35.

Medical establishments shall handle the special diagnosis and treatment and treatment of patients with infectious diseases, mental illness, occupational diseases, and so forth, in accordance with the provisions of relevant state laws and regulations. Article 33.

When medical institutions perform surgeries, special examinations or special examinations, they must obtain the consent of the patient, and shall obtain the consent and signature of the patient's family or related persons; If the patient's opinion cannot be obtained, the consent of the family member or related person shall be obtained and signed; When it is not possible to obtain the patient's opinion and no family member or related person is present, or when other special circumstances are encountered, the treating physician shall propose a medical treatment plan and implement it after obtaining the approval of the person in charge of the medical establishment or the person authorized to be responsible.

According to the regulations, there are the following 19 special diseases in the medical insurance:

Malignant tumors, chronic heart failure, chronic respiratory failure, chronic renal failure, chronic liver failure, severe Alzheimer's disease, cerebrovascular accident, megahypertension, diabetes, chronic viral hepatitis, hemophilia, systemic lupus erythematosus, Parkinson's disease, chronic aplastic anemia, severe mental disorders, tuberculosis, childhood autism, complete growth hormone deficiency, anti-rejection** after tissue and organ transplantation, etc., a total of 19 diseases.

<> According to the regulations of the National Health Security Administration of China, the special diseases in the current medical insurance mainly include: 1Critical illness, such as cancer, severe heart disease, hepatitis, DS, etc.; 2.

Rare and pure diseases, which refer to rare diseases and specific genetic diseases of Zen files; 3.Dialysis**, refers to patients with chronic renal failure and other diseases requiring renal dialysis; 4.Maternity insurance for special diseases of family planning, including anemia patients, multiple pregnancies, etc.; 5.

Critical diseases such as brain tumors, heart disease, etc., which are expensive to operate. Specific diseases may vary from region to region.

There are eight special diseases after coronary heart disease, stage III hypertension, diabetes, malignant tumors, mental illness, liver cirrhosis, kidney dialysis, and kidney transplantation. It basically covers the scope of special diseases of medical insurance, but the scope set by local medical insurance departments is different, please consult the local medical insurance department for specific conditions.

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There are 21 types of outpatient diseases, including coronary heart disease, stage III hypertension, diabetes, liver cirrhosis, mental illness, malignant tumors, kidney dialysis, kidney transplantation, Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, breast cancer (endocrine**), Wilson's disease, chronic heart failure, chronic renal insufficiency, epilepsy, bladder tumor (perfusion**), hepatitis C, liver transplantation, hematopoietic stem cell transplantation, prostate cancer (endocrine**), etc.

After the special disease is recorded, the subsequent medical expenses can be reimbursed to a certain extent. So what are the special diseases of medical insurance? How to file for these special diseases?

What is the reimbursement rate? Here's a closer look. What are the special diseases under medical insurance?

The regulations on special diseases of medical insurance vary from place to place, and the following are special diseases of medical insurance in Beijing for reference:1Evil.

The regulations on special diseases of medical insurance vary from place to place, and the following are the special diseases of medical insurance in Beijing for reference:

1.Malignant Tumor Clinic**;

2.renal dialysis;

3.Anti-rejection after kidney transplantation**;

4.Haemophilia;

5.aplastic anemia;

Sooui Bureau 6Anti-rejection after liver transplantation**;

7.Anti-rejection after combined liver-kidney transplantation**;

8.**Anti-rejection after transplantation**;

9.Anti-rejection after lung transplantation**;

10.multiple sclerosis;

11.Intraocular injections for macular degeneration**.

Filing process for special diseases.

1.Local medical filing process.

Insured persons who have filed for special diseases in hospitals in this city need to go to the designated hospital for special diseases selected by them with their social security cards for the record.

Collect and fill in the "Beijing Medical Insurance Special Disease Filing Form" at the hospital as required, go through the filing procedures at the hospital medical insurance office after the doctor signs, and issue a stamped "Beijing Medical Insurance Special Disease Filing Form" after verification by the hospital, and keep a copy of the insured individual.

2.Filing process for medical treatment in other places.

Insured persons who are resettled in other places or who are stationed in other places for long-term staff who choose to go to a designated hospital in other places for special disease filing shall go through the filing procedures at the medical insurance center of the insured district (county).

When filing for the record, the insured person needs to hold the social security card, the diagnosis certificate of special diseases issued by the designated medical institution and the completed and stamped "Beijing Medical Insurance Special Disease Filing Form", and the medical insurance center will issue a stamped "Beijing Medical Insurance Special Disease Filing Form" after verification, and the insured individual shall retain a copy.

Note: Insured persons suffering from "multiple sclerosis" are required to provide a certificate of diagnosis issued by the deputy chief physician or above when applying for the filing of special diseases for the first time.

Change process for special diseases.

1.Local ICP filing change process.

If the local special disease filing has not expired, and the insured person needs to change the designated medical institution for special diseases due to his or her illness, he or she shall go to the designated hospital for the original special disease with his social security card to go through the cancellation procedures.

Before going through the cancellation procedures, the special disease fees of the original designated hospital should be settled, and the original designated hospital for special diseases should issue the "Beijing Medical Insurance Special Disease Filing and Cancellation Form", and the next day with the social security card and the "Beijing Medical Insurance Special Disease Filing and Cancellation Form" to the newly selected local special disease designated hospital to go through the filing procedures again.

Clan Trapped 2Procedures for changing ICP filing in different places.

If the record for special diseases in other places has not expired, and the insured person needs to change the designated medical institution for special diseases due to his or her illness, he or she shall go through the cancellation procedures at the medical insurance center of the insured district (county) with the social security card and the change description of the special disease hospital issued by the unit.

Special diseases include the following 20 types: (1) radiotherapy, chemotherapy and analgesia for malignant tumors**; (2) Dialysis for patients with renal failure**; (3) Anti-rejection after kidney, liver, heart valve, hematopoietic stem cell transplantation**; (4) Diabetes mellitus; (5) Systemic lupus erythematosus; (6) Hypertension; (7) Coronary heart disease; (8) Rheumatic heart disease; (9) Sequelae of cerebrovascular accident; (10) Bronchial asthma, chronic bronchitis with obstructive emphysema, chronic cor pulmonale; (11) Liver cirrhosis (decompensated); (12) Aplastic anemia; (13) Psychiatric disorder; (14) Tuberculosis; (15) Hemophilia; (16) Severe prostatic hyperplasia; (17), rheumatoid arthritis; (18), Parkinson's disease; (19), amyotrophic lateral sclerosis; (20) Bone marrow proliferative diseases (polycythemia vera, essential thrombocythemia, primary myelofibrosis).

Article 25 of the Social Insurance Law The State shall establish and improve the basic medical care 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 from low-income families, and minors who need to pay the part of the individual contributions shall be subsidized by **.

Special diseases include the following 20 types: (1) radiotherapy, chemotherapy and analgesia for malignant tumors**; (2) Dialysis of patients with renal failure in the field of covering**; (3) Anti-rejection of foreign bodies after kidney, liver, heart valve, and hematopoietic stem cell transplantation; (4), Diabetic Song; (5) Systemic lupus erythematosus; (6) Hypertension; (7) Coronary heart disease; (8) Rheumatic heart disease; (9) Sequelae of cerebrovascular accident; (10) Bronchial asthma, chronic bronchitis with obstructive emphysema, chronic cor pulmonale; (11) Liver cirrhosis (decompensated); (12) Aplastic anemia; (13) Psychiatric disorder; (14) Tuberculosis; (15) Hemophilia; (16) Severe prostatic hyperplasia; (17), rheumatoid arthritis; (18), Parkinson's disease; (19), amyotrophic lateral sclerosis; (20) Myeloproliferative diseases (polycythemia vera, essential thrombocythemia, primary myelofibrosis).