Reimbursement ratio of medical insurance for uremic workers

Uremia patients are seriously ill in outpatient department. As long as you participate in medical insurance, dialysis and other treatment expenses, you will be reimbursed 90% according to the regulations, and individuals only need to pay 10%. Different places have different regulations on medical treatment and reimbursement of uremia, so you can go to the local medical insurance consultation. Take Guangzhou as an example:

First, the designated medical institutions designated by the municipal medical insurance management department were diagnosed through inspection. Insured persons who need long-term outpatient peritoneal dialysis and hemodialysis treatment (hereinafter referred to as insured patients) can enjoy medical insurance benefits for uremia outpatient dialysis treatment according to regulations.

Second, the insured patients should choose a designated medical institution (hereinafter referred to as the selected hospital) in the designated medical institution 1. Once selected, in principle, it cannot be changed within 1 year. Insured patients really need to change the selected hospital due to illness, migration of residence and other reasons, and can go through the change procedures in the medical insurance agency.

Three, designated medical institutions to provide outpatient dialysis treatment for insured patients to implement the management of medical insurance responsible doctors, and unified use of social medical insurance outpatient special project medical records. Specific measures by the medical insurance agencies and designated medical institutions signed a service agreement.

Four, the insured uremia outpatient dialysis treatment of basic medical expenses, basic medical insurance fund payment ratio, respectively, according to the relevant provisions of the city's basic medical insurance for urban workers, basic medical insurance for urban residents and basic medical insurance for urban flexible employees.

Five, the basic medical insurance fund to pay the basic medical expenses of the insured patients with uremia outpatient dialysis treatment, should be in line with the "Notice on the publication of Guangzhou social medical insurance outpatient specific projects, outpatient designated chronic disease drugs directory scope" (Sui Ren She Fa [2012] No.50) and "Guangzhou basic medical insurance uremia outpatient dialysis treatment project scope" (annex). Among them, for drugs and diagnosis and treatment projects belonging to Class B, the cost standard of insured patients is adjusted to zero in proportion.

The basic medical expenses of uremia patients in outpatient dialysis treatment in non-selected hospitals will not be paid by the basic medical insurance fund.

Six, insured uremia patients outpatient dialysis treatment of medical expenses, belonging to the basic medical insurance fund to pay, by the designated medical institutions first accounting, monthly summary to the medical insurance agencies to declare settlement.

Seven, the municipal medical insurance agencies according to the average cost quota and designated medical institutions for outpatient dialysis basic medical expenses settlement.

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