Single disease reimbursement policy

Reimbursement for a single disease is generally limited, that is, the social security agency determines that the treatment cost of the disease is a fixed amount and does not involve cost accounting. In short, clearly define how much a disease costs, avoid medical units abusing medical service items, repeating items and decomposing items, prevent minor diseases from being cured in hospitals and ensure the quality of medical services. If it is not a single disease, it should be accounted according to the deductible line of the parties and the specific amount of expenses, and the reimbursement shall be subject to the accounting results.

The specific medical expenses quota standard is based on the second-level hospitals, and the first-level hospitals are reduced by 5% on the basis of the second-level hospitals; On the basis of secondary hospitals, tertiary hospitals increased by 10%. The reimbursement standards for single diseases are also divided into employee medical insurance and resident medical insurance, and employee medical insurance is divided into on-the-job and retirement. Among them, the on-the-job insured can be reimbursed at least 85%.

Specifically, single disease reimbursement needs to meet the following conditions:

1. was diagnosed as a specific disease, such as cancer, diabetes, etc.

2. The treatment process conforms to the requirements of disease diagnosis and treatment norms and medical insurance payment policies. For example, the cost of chemotherapy for cancer patients should meet the "Diagnostic and Therapeutic Standards for Cancer Diseases" promulgated by the Ministry of Health.

3. Treat in a designated clinic.

4. The medical insurance fund gives limited payment, that is, the expenses paid by the medical insurance part are limited, and the excess part needs to be borne by itself.

In short, reimbursement for a single disease needs to meet certain policy requirements and medical standards in order to enjoy medical insurance reimbursement. The specific reimbursement standards and policies are subject to the local medical insurance bureau.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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