How to handle social security and special diseases in Wenzhou, Zhejiang? I have thrombocytopenia and spent a lot of savings at home. Can I apply?

I. Special social security diseases 12, as follows:

1. Chronic pulmonary heart disease

2. Leukemia and aplastic anemia

3. Chronic renal failure

4. Sequela of cerebrovascular accident

5. Intracranial space occupying lesions

6. Space occupying lesions in spinal canal

7. Malignant tumors in various systems of the whole body

8. Cardiac insufficiency is above Grade III (including Grade III)

9. Liver function decompensation stage of liver cirrhosis

/kloc-0 0. Schizophrenia

1 1. Severe emotional and mental disorders

12. Hemophilia

Two, social security management of special diseases:

1. Social security patients need to show a "special disease card" to treat special diseases, and doctors need to prescribe drugs, check and test in the "special disease order module" of outpatient doctor workstation.

2. The scope of enjoyment of special diseases refers to drugs, inspections and tests related to special diseases; Patients who have nothing to do with special diseases and should enjoy reimbursement according to the proportion of ordinary social security, doctors need to be in the general doctor's advice module of the outpatient doctor's workstation.

3. The proportion of social security payment for outpatient special diseases is stipulated: 75% of the annual outpatient medical expenses for special diseases below 20,000 yuan shall be paid by the overall fund; 20 thousand yuan to 40 thousand yuan, 80% paid by the overall fund; 40 thousand yuan to 60 thousand yuan, 85% paid by the overall fund; 60 thousand yuan to 80 thousand yuan, 90% paid by the overall fund; More than 80,000 yuan is paid by 90% of medical assistance for major diseases.

4. Provisions on the proportion of social security payment for hospitalization special diseases: For patients suffering from various malignant tumors who need to be hospitalized for multiple times for radiotherapy and chemotherapy, every 90 days is a settlement period, and the actual medical expenses are calculated according to the highest level of designated medical institutions at the time of hospitalization, and reimbursed according to the hospitalization reimbursement standard. Non-radiotherapy and chemotherapy treatment shall be settled by general hospital credit card.

How to deal with it is as follows:

Article 1 In order to further improve the basic medical insurance system, ensure the basic medical needs of patients with special chronic diseases who participate in the basic medical insurance, and reduce the personal burden, these Measures are formulated in accordance with the relevant provisions of the state and the province, combined with the situation of this Municipality.

Article 2 Anyone who participates in urban basic medical insurance or in-patient medical co-ordination within the administrative area of this Municipality and suffers from designated special chronic diseases may apply for medical expenses subsidies for outpatient treatment of special chronic diseases in accordance with these Measures.

Article 3 These Measures shall be implemented by the municipal labor and social security department.

The municipal medical insurance agency undertakes the management and service of medical expenses subsidies for outpatient treatment of special chronic diseases.

Article 4 Persons suffering from the following special chronic diseases may apply for subsidies for outpatient treatment of special chronic diseases:

(1) Hypertension complications (Grade 3, with one of heart, brain, kidney, aorta or retinopathy);

(2) Accidental hemiplegia due to cerebral hemorrhage or cerebral infarction;

(three) coronary heart disease (old myocardial infarction or cardiac insufficiency above grade 3);

(four) diabetes (combined with arterial disease, nephropathy or retinopathy of limbs);

(5) decompensated stage of liver cirrhosis;

(six) outpatient blood (peritoneal) dialysis treatment;

(7) Anti-rejection therapy after liver and kidney transplantation;

(8) Non-severe aplastic anemia.

Article 5 The medical diagnostic criteria for outpatient treatment of special chronic diseases shall be formulated by the municipal expert appraisal committee for outpatient treatment of special chronic diseases.

Article 6 Persons applying for outpatient medical assistance for special chronic diseases shall apply to the municipal medical insurance agency with relevant medical data within the specified time. Medical insurance agencies organize experts to pass the preliminary examination, and after passing the physical examination, submit them to the Municipal Expert Appraisal Committee for outpatient treatment of special chronic diseases for approval.

For critically ill patients with mobility difficulties, the municipal medical insurance agency will provide on-site service.

Seventh approved by the special chronic disease outpatient treatment of medical expenses subsidies, by the municipal medical insurance agencies issued a unified "Harbin medical insurance special chronic disease outpatient treatment certificate".

Eighth people who enjoy Medicaid for outpatient treatment of special chronic diseases shall enjoy Medicaid for outpatient treatment of special chronic diseases from the second month after obtaining the Medical Insurance Certificate for Outpatient Treatment of Special Chronic Diseases in Harbin.

Ninth to enjoy the medical expenses subsidies for special chronic diseases in Item (1), (2) and (3) of Article 4 of these Measures, the medical insurance fund shall subsidize 450 yuan every quarter; Enjoy the fourth (four), (five), (six), (seven) and (eight) of these measures, and the medical insurance fund will subsidize 600 yuan every quarter. Enjoy more than two kinds of special chronic disease medical expenses subsidies, according to the quarterly 600 yuan subsidies.

Tenth special chronic disease outpatient treatment of medical expenses subsidy standards and payment standards, by the municipal labor and social security administrative department according to the accumulation of funds, in accordance with the principle of "balance of payments" of medical insurance funds to adjust.

Eleventh special chronic disease outpatient treatment medical expenses subsidies included in my special chronic disease outpatient treatment medical expenses subsidy account, when there is a balance, can be carried forward to the next year to continue to use.

Twelfth people who enjoy medical subsidies for outpatient treatment of special chronic diseases must hold the "Harbin Medical Insurance Outpatient Treatment Certificate for Special Chronic Diseases" and buy drugs for chronic diseases in designated medical institutions and retail pharmacies. The subsidy account for outpatient treatment of special chronic diseases shall not be used to pay the treatment and drug expenses unrelated to outpatient treatment of special chronic diseases.

Thirteenth enjoy special chronic disease outpatient treatment of medical expenses subsidies, unpaid medical insurance premiums, stop subsidies; After the arrears are paid, the original medical treatment will be restored.

Fourteenth city medical insurance agencies every 2 years to enjoy special chronic disease outpatient medical expenses subsidies for a review. For those who do not meet the conditions of special chronic disease outpatient Medicaid after examination, stop the special chronic disease outpatient Medicaid.

Fifteenth designated medical institutions and retail pharmacies for chronic diseases shall provide corresponding treatments and medicines according to special chronic diseases when providing treatment and medicines to those who enjoy medical expenses subsidies for outpatient treatment of special chronic diseases; Do not use the special chronic disease outpatient Medicaid account to provide treatments and drugs unrelated to the special chronic disease outpatient Medicaid.

Article 16 When applying for outpatient medical assistance for special chronic diseases, authentic and reliable materials shall be provided, and it is not allowed to defraud outpatient medical assistance for special chronic diseases by providing false materials or taking medical examinations under false names.

Seventeenth enjoy special chronic disease outpatient treatment of medical expenses subsidies after the death, their units or their families should be timely to the municipal medical insurance agencies for special chronic disease outpatient treatment of medical expenses subsidies termination procedures.

Eighteenth medical insurance management staff are not allowed to have the following acts:

(a) the subsidy is not included in the special chronic disease outpatient treatment medical expenses subsidy account according to the regulations;

(two) corruption, misappropriation of special chronic disease outpatient treatment of medical expenses subsidies.

Nineteenth in violation of the provisions of these measures, the municipal labor security administrative department shall order it to make corrections within a time limit, and if it fails to make corrections within the time limit, it shall be handled according to the following provisions; If the case constitutes a crime, criminal responsibility shall be investigated according to law:

(a) in violation of the provisions of article fifteenth of these measures, impose a fine of more than 3 times and less than 5 times the illegal amount, resulting in adverse consequences, the administrative department of labor security may cancel its designated qualification;

(two) in violation of the provisions of Article sixteenth and Article seventeenth of these measures, the funds included in the special chronic disease outpatient treatment subsidy account shall be recovered and a fine of 500 yuan 1 000 yuan shall be imposed.

Twentieth medical insurance management staff in violation of the provisions of article eighteenth of these measures, shall be given administrative sanctions; If a crime is constituted, criminal responsibility shall be investigated according to law.

Twenty-first the implementation since June 6, 2007.

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