How much is reimbursed by medical insurance for special diseases, and the reimbursement ratio of spe

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 reimbursing:

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.

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Hello I am very happy to answer this question for you, about your question, after inquiry, the starting line for chronic diseases of employees is 300 yuan, the reimbursement ratio of expenses within the policy is unified at 80%, the maximum payment limit for a single disease is 2000 yuan (of which the maximum payment limit for mental illness is 3000 yuan), and the maximum payment limit for each additional disease is 1000 yuan, and the maximum payment limit is 5000 yuan per year. The minimum payment line for special diseases of employees is 880 yuan, and the reimbursement ratio is to enjoy the reimbursement treatment of hospitalization, calculated according to the level of the hospital, of which there is no starting line for chronic renal failure and severe mental illness, and the reimbursement ratio within the policy is 90%. There is no minimum payment line for chronic diseases in urban and rural residents, the reimbursement ratio is 20% of the cost within the scope of the medical insurance policy, the maximum payment limit for a single disease is 2,000 yuan (of which the maximum payment limit for mental illness is 3,000 yuan), and each additional disease increases by 1,000 yuan, and the maximum annual payment limit is 5,000 yuan

Modular law analysis in law:

The reimbursement for special outpatient clinics is the same as that for the inpatient reimbursement of the extremity when certain conditions are met. Reimbursement ratio for outpatient clinics for special diseases: 1. Employee medical insurance; In a medical insurance year, the minimum payment line for outpatient services for special diseases is 400 yuan, and the reimbursement ratio of medical expenses within the scope of the specified ** is the same as that of ordinary hospitalization.

2. Medical insurance for urban and rural residents; In a medical insurance year, the minimum payment line for outpatient services for special diseases is 400 yuan, and the reimbursement ratio of medical expenses within the scope of the specified ** is the same as that of ordinary hospitalization.

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 employees 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: The State is to 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 The State shall establish Chi Peishi 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 **.

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

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.

How much can be reimbursed for special diseases, it depends on what you see, under normal circumstances, there are more reimbursements in the county, and less reimbursement in the city.

Reimbursement of medical expenses for special prescribed diseases:

From the 1st to the 10th of each month, the unit shall submit the reimbursement materials to the relevant medical examination department of the medical insurance center.

Reimbursement materials to be provided for reimbursement of special diseases:

1. Fill in the "Medical Insurance Employee Medical Expense Declaration Schedule" and sign it;

2. Medical insurance outpatient medical bills and prescriptions;

3. Copies of outpatient medical records, outpatient medical records for special diseases and related records;

4. For reimbursement of medical expenses transferred to non-designated medical institutions and resettled personnel due to emergency or medical insurance center approval, medical expense details, prescriptions, long-term medical orders, and temporary medical orders shall be provided;

5. A copy of the "Approval Form for Special Prescribed Diseases".

Reimbursement process for special diseases:

Patients who have undergone outpatient treatment for special diseases;

Eligible for special outpatient diseases**;

Hold a health insurance card or ID card**;

Inform the Billing Office for a special outpatient consultation**;

Visits to relevant departments;

The doctor enters the "special outpatient" window to issue medical orders;

Settle the medical insurance bill with the medical insurance card or ID card.

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