2023 chronic disease reimbursement policy

The reimbursement policy for chronic diseases in 2023 is as follows:

1. Starting payment standard:

(1) The starting payment standard for chronic diseases in designated community health service organizations is 200 yuan. The designated first-class specialized hospital chronic disease starting payment standard is 200 yuan, the designated second-class specialized hospital chronic disease starting payment standard is 400 yuan. Above the starting standard, the outpatient chronic disease annual maximum payment limit of medical expenses are reimbursed proportionally, the outpatient coordinated fund to pay 50%;

(2) suffering from two or more outpatient chronic diseases, in accordance with the principle of "the higher, not the lower," the determination of the annual payment limit, per person per year, the payment limit increased by 200 yuan.

(3) Patients with outpatient chronic diseases are not entitled to outpatient medical treatment during hospitalization, and when calculating the maximum payment limit of basic medical insurance, the outpatient medical expenses are combined with the inpatient medical expenses.

(4) The outpatient medical treatment for special diseases is implemented according to the standard of hospitalization, and the starting line is calculated only once in one insurance year, and the starting standard is implemented according to the standard of the level of the hospital visited.

2. Reimbursement rate:

(1) Reimbursement rate for chronic diseases: 50% for adult residents paying at the low-grade standard; 60% for underage residents and adult residents paying at the high-grade standard;

(2) Reimbursement of outpatient treatment expenses for radiotherapy for malignant tumors, dialysis treatment for uremic syndrome, and antirejection medication for tissue and organ transplantation is not subject to a threshold. The reimbursement rate is 70% for adult residents paying at the low-grade standard, and 80% for minor residents and adult residents paying at the high-grade standard;

(3) The annual reimbursement limit for dialysis treatment for uremia and anti-rejection medication after tissue organ transplantation: the limit for adult residents paying at the low-grade standard is 60,000 yuan. The limit is 80,000 yuan for minor residents and adult residents paying at the high-tier rate;

(4) Chronic disease benefits are available to participants of enterprises, institutions and organizations, and individual participants who are flexibly employed.

The process of applying for the chronic disease card is as follows:

1. The patient himself applies to the social security center and fills in the official application form;

2. The diagnostic certificates from the hospitals of the second level or higher are reported to the social security center, and after the expert committee's appraisal and examination, the chronic disease certificate is processed. The expert committee's appraisal of chronic diseases is held once a quarter, and the expenses required for the appraisal are borne by the individual or the unit;

3. The patient sees the doctor and buys medicine at the outpatient department of the designated hospital;

4. Within the stipulated time, the patient goes to the social security center to be reimbursed for the medical expenses of the chronic disease, and at the same time, the "list of the outpatient medical expenses of the chronic disease" is filed together with the prescriptions, invoices, the certificate of the chronic disease, the medical records, and the examination report slips of all kinds. The "Chronic Disease Outpatient Medical Expense List" with prescriptions, invoices, chronic disease certificates, medical records, various examination reports, etc. will be filed. It should be noted that when applying for reimbursement of chronic diseases, each person can declare a maximum of three chronic diseases.

In summary, suffering from hypertension, high blood pressure, diabetes, cirrhosis of the liver, pulmonary heart disease, tuberculosis, rheumatoid arthritis, chronic viral hepatitis and other chronic diseases, in line with the requirements of the hospital to get the hospital to open the identification of chronic diseases form, and later in the outpatient clinic to buy medicines, you can be reimbursed for a part of the cost.

Legal basis:

Article 23 of the Social Insurance Law of the People's Republic of China

Employees shall participate in the basic medical insurance for employees, and employers and employees shall pay the basic medical insurance premiums in accordance with the state regulations***. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in the employing organization, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.