How to reimburse outpatient medical insurance for special diseases

Legal analysis: reimbursement standard for outpatient special diseases: (total outpatient expenses-all at their own expense-Qifubiaozhun-individual pays first) multiplied by the compensation ratio. Reimbursement ratio: urban workers can be reimbursed 85%, with an increase of 2% for those over 50, 4% or 89% for those over 60, 6% for those over 70 and 8% for those over 80 (inclusive), and the reimbursement ratio is within 100%. Urban and rural residents: low-grade payment and students and children: the reimbursement ratio is 50%; The reimbursement rate of high-level payers is 65%. The diseases that can be reimbursed by outpatient medical insurance for special diseases include: liver cirrhosis, psychosis, malignant tumor, hepatolenticular degeneration, hepatitis C, Parkinson's disease, rheumatoid arthritis, coronary heart disease, hypertension III, diabetes, renal dialysis, kidney transplantation, chronic heart failure, chronic renal insufficiency, systemic lupus erythematosus, breast cancer (endocrine therapy), liver transplantation, hematopoietic stem cell transplantation and prostate cancer (endocrine therapy).

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

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

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.