Kidney disease applies for medical insurance for chronic diseases, and medical insurance for chronic

Hello, in 2014, the reimbursement ratio of medical insurance in Shandong will be raised, and the reimbursement ratio of medical expenses within the scope of the medical insurance hospitalization policy for employees and urban residents in Shandong Province will be increased to more than 75% and 70% respectively. The maximum annual payment limit of basic medical insurance for urban residents in Qingdao has been increased to 10,000 yuan, and the maximum payment limit for urban employees' medical insurance is 200,000 yuan. This further provides good conditions for patients with kidney disease**.

Qingdao Jingkang Traditional Chinese Medicine Nephrology Hospital understands the financial burden of patients with kidney disease and is the conscience hospital of kidney disease.

Qingdao Jingkang Hospital is a second-class nephrology hospital under the state, a national key kidney disease hospital, and a designated unit of national urban medical insurance and NCMS, which can be reimbursed by medical insurance, and can assist in handling relevant transfer and reimbursement procedures for patients who want to come from other places. Provide a first-class diagnosis and treatment platform for patients with kidney disease.

1. Application conditions: Insured persons participating in supplementary medical insurance, including:

1. Suffering from 12 chronic diseases: diabetes, hypertension (stage), chronic hepatitis (except hepatitis A), malignant tumors, coronary heart disease, Parkinlin's disease, sequelae of stroke (including cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage), chronic bronchitis (including bronchial asthma), chronic nephritis (including renal insufficiency), rheumatoid arthritis, systemic erythema, chronic aplastic anemia.

2. Co-ordinate the medical expenses with a maximum payment limit of more than 40,000 yuan.

II. Handling Procedures:

1) The outpatient expenses of 12 chronic diseases exceed 800 yuan, and the supplementary medical insurance** payment ratio is 70%, and the maximum payment limit is 2,500 yuan; If the self-payment exceeds 600 yuan for those over 70 years old, the supplementary medical insurance ** payment ratio is 80%, and the maximum payment limit is 3,000 yuan.

2) Co-ordinate the part with a maximum payment limit of more than 40,000 yuan, and 90% of the supplementary medical insurance**, with a maximum payment limit of 160,000 yuan.

3. Bring the required materials to the local social security department for processing, and consult the local social security department for details.

Application materials: original and photocopy of resident ID card, social security card, a recent one-inch bareheaded color **, a copy of the inpatient medical record related to the declared disease (stamped with the special seal for the photocopying of the hospital's inpatient medical record) and related imaging data (such as X-ray, CT film and examination report, etc.).

4. Wait for the reimbursement to be issued.

Legal Analysis:

1. Suffering from 12 chronic diseases: diabetes, hypertension (stage), chronic hepatitis (except hepatitis A), malignant tumors, coronary heart disease, Parkinlin's disease, sequelae of stroke (including cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage), chronic bronchitis (including bronchial asthma), chronic nephritis (including renal insufficiency), rheumatoid arthritis, systemic erythema, chronic aplastic anemia.

2. Co-ordinate the medical expenses with a maximum payment limit of more than 40,000 yuan.

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

Article 4 Employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with law have the right to inquire about payment records and records of individual rights and interests, and to request social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise their own units' contributions for them.

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 27 Individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, the cumulative contributions reach the number of years prescribed by the State, and they will no longer pay the basic medical insurance premiums after retirement, and enjoy the basic medical insurance benefits in accordance with the provisions of the State; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state. Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Chronic Disease Medical Insurance Reimbursement Process:

1. The patient shall submit an application 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 will conduct the appraisal of chronic diseases once a quarter, and the cost of the appraisal shall be 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.

The reimbursement rates for chronic nephritis are as follows:

1. The reimbursement ratio for adult residents who pay according to the low-grade standard is 50%;

2. The reimbursement ratio for juvenile residents and adult residents who pay according to high-end standards is 60%.

The minimum reimbursement standard for chronic nephritis is 300 yuan. For malignant tumors after radiotherapy and chemotherapy, uremia dialysis**, and tissue and organ transplantation, there is no threshold for reimbursement of outpatient expenses, 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%. The annual cost of taking anti-rejection drugs after uremia dialysis ** and tissue and organ transplantation shall be reported to the source of the repression quota standard:

The limit for adult residents who pay according to the low-end standard is 60,000 yuan, and the limit for juvenile residents and adult residents who pay according to the high-end standard is 80,000 yuan.

The application materials for reimbursement of chronic nephritis include: the original and photocopy of the resident ID card, the social security card, a recent one-inch bareheaded color**, a copy of the inpatient medical record related to the declared disease (stamped with the special seal for the photocopying of the hospital's inpatient medical record) and relevant imaging data.

That's all for this question, I hope it helps.

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

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance split ** payment. Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance shall be settled directly by the social insurance agency and the medical institution and the drug business unit.

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Application conditions for chronic disease medical insurance registration.

1.Consumers who have participated in local basic medical insurance and paid in full;

2.The disease is a chronic disease specified in the medical insurance.

Documents required for chronic disease medical insurance registration.

1Receive the original "Certificate of Diagnosis of Chronic Diseases Designated by Medical Insurance";

2.The original and photocopy of the medical record data, and the photocopy will be collected;

3. If it is an entrusted agent (individual), the following information needs to be provided:

1) The original and photocopy of the client's social medical insurance certificate (social security card or medical insurance card);

2) The original and copy of the client's ID card;

3) The original and photocopy of the entrusted person's ID card.

4) Original power of attorney.

Remarks: Shoubi Prefecture 1The materials to be collected are A4 specifications;

2.The social medical insurance voucher and ID card that need to be photocopied are photocopied on the front and back.