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Special diseases。Chronic diseases can apply for the identification of outpatient special diseases and enjoy the prescribed outpatient special disease treatment. For ordinary people.
It is a big benefit, the medical insurance who has obtained the outpatient special disease and chronic disease medical card can enjoy the same proportion of medical reimbursement treatment as hospitalization when visiting a doctor and taking medicine in the outpatient clinic, and the medical reimbursement only needs to go to the local designated hospital for relevant business processing. <>
Nowadays, the times are constantly evolving, and people are interested in the health insurance system.
The degree of understanding is also getting deeper and deeper, and for patients with outpatient special diseases and chronic diseases, they have passed through tertiary hospitals.
Persons diagnosed with special diseases and chronic diseases can have relevant medical records.
or the examination results and other relevant materials to the county-level medical insurance institutions in the place of insurance to apply for special outpatient services.
Medical card, participate in the relevant reimbursement procedures. <>
What are the uses of medical insurance special disease chronic disease treatment card?
Medical insurance in the outpatient special disease chronic disease medical card, is a special care for the medical insurance personnel suffering from special diseases and chronic diseases, as long as you meet the relevant standards can bring the relevant documents to the local hospital to enjoy the same medical insurance as hospitalization, treatment can be reimbursed at the time of hospital settlement, do not need to pay for their own expenses and then reimbursement, in life we should also learn to pick up the law to defend their legitimate rights and interests, encounter things that can not be reimbursed normally, The first time to carry out the relevant business, can effectively protect their legitimate rights and interests from infringement. <>
How should the relevant business be handled?
For people with special diseases and chronic diseases, you can go to the local social security department to handle it, you only need to fill out an application ** submit the hospital's examination and diagnosis certificate ** case, and wait for the certificate after being reviewed and determined by the medical insurance department, but it should be noted that in the process of handling, you must tell the truth to avoid affecting your normal rights and interests due to concealment and lying, I hope everyone can realize this, the outpatient medical card can only be used in designated hospitals, and not all hospitals can be passed.
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Chronic disease and special disease medical card refers to a person who has participated in urban employee medical insurance or urban and rural residents' medical insurance, if he suffers from special diseases, chronic diseases and other diseases that require long-term **. After such patients have passed a certain period of hospitalization, there is no need to be hospitalized again, as long as they go through the outpatient clinic of a designated hospital, they can carry out related ** or purchase ** drugs.
The reimbursement of outpatient expenses is the same as the reimbursement of hospitalization expenses, which is reimbursed at the time of hospital settlement, and there is no need to pay for reimbursement later.
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You can make better reimbursement, better solve problems, avoid complicated procedures, and need to have receipts and diagnosis certificates after seeing a doctor, and then you can be reimbursed.
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The following conditions are required for reimbursement of special outpatient chronic diseases:
1. Write an application in the name of the insured and write it to the social security management bank office in the area where the household registration belongs;
2. Outpatient medical records of ** diseases, hospitalization records within two years, including discharge summary, original and photocopy;
3. Fill in the application form for severe illness at the social security office of the household registration jurisdiction;
4. Together with the above information, send it to the district and the Medical Insurance Department of the Social Security Management Office of the Cultivation Area for review.
What documents are required for medical insurance reimbursement.
The following documents are required for medical insurance reimbursement:
1. ID card, medical insurance card;
2. Disease diagnosis certificate and outpatient medical records, examination and test results report issued by designated medical institutions;
3. Charging documents and relevant invoices issued by medical institutions.
Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China.
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance in accordance with national regulations. Desperate only.
Article 29.
The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled 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.
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Dear, hello, I am happy to answer for you that you have already handled a special chronic disease but you can't report the fee to the outpatient clinic The reason is to take the medical insurance card and medical records to the hospital where the household registration is located to apply! Only after passing the review can the outpatients with common chronic missing diseases be reimbursed, they must hold the "Chronic Disease Medical Card" and their identity documents must be treated in designated medical institutions in the district, and immediate settlement and reimbursement will be implemented. That is to say, as long as you see a doctor in the medical structure designated by the medical insurance, you only need to bring the chronic medical card and ID card for real-time reimbursement, and you don't need to consider the reimbursement problem, and you can directly deduct it when you pay the fee.
In addition, special chronic diseases and large-value outpatient clinics must be presented with ID cards, invoices, outpatient medical records and other materials, which shall be approved by the District NCMS Management Center and compensated, which can be settled and reported once a quarter. Outpatient clinics in other places (outside the province) are not eligible for reimbursement.
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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 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 through the reimbursement procedures with the prescribed materials to the Jinan social security institution.
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.
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) High blood pressure;
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), cirrhosis (decompensation);
12) Aplastic anemia;
13) Psychiatric disorders;
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).
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1.Medication must be prescribed at a designated hospital. Other hospitals are ineffective.
2.Explain this at the time of your appointment.
3.It must be the drug of the chronic disease, and the insured persons who have not handled the "special disease" within the scope of reimbursement shall pay the medical expenses incurred in the outpatient treatment of the selected designated medical institutions, and the personal burden shall be paid by the insured patients with their personal accounts, and the personal accounts shall be paid by the individuals in cash.
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For special chronic diseases, you need to go to the hospital designated by the medical insurance and pick up the medicine in accordance with the provisions of the local medical insurance, that is, go to the hospital designated by the medical insurance and pick up the medicine at the drug sales store, so that the corresponding expenses can be directly reimbursed and deducted.
Specify the hospitals and pharmacies to contact your local health insurance department and they will tell you.
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