Physical examination results of occupational diseases in Pingmei Shenma Group

Interim Measures for Medical Management of Serious Chronic Diseases of Urban Workers in Pingdingshan City (No.59 [2007] of Pinglao Society)

Article 1 In order to further improve the medical management of serious chronic diseases and reduce the economic burden of the insured persons with serious chronic diseases, according to the Interim Measures for Basic Medical Insurance for Urban Workers in Pingdingshan City (No.Heizheng [1999]86).

Article 2 A serious chronic disease refers to a medical insurance disease in which the insured suffers from a serious disease that meets the hospitalization conditions and needs long-term treatment or drug support, and the expenses are paid by the overall fund according to the regulations (see the attached table).

Third insured persons suffering from one of the diseases listed in these measures and meet the basic diagnostic conditions, can apply for outpatient treatment.

Those who apply for outpatient treatment need to fill in the Application Form for Identification of Severe Chronic Diseases in Pingdingshan City as required, and provide the diagnosis certificate and related materials (recent hospitalization medical records, laboratory sheets, inspection reports, etc.). ) designated medical institutions, and submitted by the employer to the medical insurance agency.

Article 4 The medical insurance agency shall organize experts to identify severe chronic diseases, and issue the Manual for Outpatient Treatment of Severe Chronic Diseases to those who meet the conditions for outpatient treatment of severe chronic diseases.

Identification work is organized once every six months (see Annex 2 for the identification procedures of severe chronic diseases).

Article 5 The management of serious and chronic diseases shall be subject to the "Five Definitions", that is, medical units, treatment time, medication scope, treatment project scope and expense limit. If the insured suffers from more than/kloc-0 kinds of serious and chronic diseases that meet the requirements at the same time, the medical expenses quota shall be implemented according to the highest disease type.

Sixth patients with severe chronic diseases, I should choose qualified designated medical institutions for treatment. In the approved treatment period, I generally can't change the designated medical institutions, and I can choose again when I apply at the expiration.

Community medical service institutions that meet the designated points may apply for undertaking medical services for serious and chronic diseases.

Article 7 The approved treatment period for chronic diseases is 6 months at most. If it is really necessary to extend the treatment due to illness, a new application shall be made.

Eighth outpatient treatment of serious chronic diseases of medical expenses to implement accounting and settlement management (except anti-rejection treatment after organ transplantation). Patients with severe chronic diseases go to designated medical institutions for medical treatment, and go through accounting procedures according to hospitalization procedures with the Manual for Outpatient Treatment of Severe Chronic Diseases. After the end of medical treatment, the expenses paid by the overall fund according to the regulations shall be settled directly by the medical insurance agency to the hospital, and the personal burden shall be settled by the individual.

Ninth designated medical institutions should set up a special management department for patients with severe chronic diseases, establish medical records, and completely record their condition changes and diagnosis and treatment. The management department of serious chronic diseases and the attending doctor should give reasonable treatment and examination according to the condition. The drug list and diagnosis and treatment items shall be implemented according to the provisions of the basic medical insurance. The restricted use scope of drugs in the drug list is also applicable to patients with severe chronic diseases. Drugs restricted for outpatient use belong to drugs that are not paid by the overall fund and do not belong to the scope of chronic disease treatment.

Patients with chronic diseases need consultation from other departments due to their illness, and the expenses for treatment and medication after consultation can be included in the scope of payment.

Eleventh patients with chronic diseases in non-selected designated medical institutions or medical expenses incurred in non-designated medical institutions, the overall fund will not pay.

Eleventh chronic renal failure, malignant tumor, organ transplantation after anti-rejection treatment of medical expenses paid according to the hospitalization standard; There is no deductible for outpatient medical expenses of other serious and chronic diseases, regardless of the number of hospitalizations, and it is not calculated in sections. 70% of the reasonable medical expenses incurred by employees are paid by the overall fund, and 75% of retirees are paid by the overall fund.

Twelfth chronic medical expenses paid by the overall fund, included in the annual overall fund or the maximum payment limit for serious illness relief.

Article 13 These Measures shall be implemented as of the date of promulgation.