What is the scope of medical insurance reimbursement for serious illness and cancer in Sichuan?

The establishment of a serious illness cancer insurance system aims to reduce the burden of medical expenses for serious illness cancer of urban and rural residents and promote the gradual solution of the problems of poverty caused by illness and returning to poverty due to illness. So what is the scope of medical insurance reimbursement for serious illness and cancer in Sichuan? Generally speaking, it refers to the sum of medical expenses that meet the medical insurance drug list, diagnosis and treatment items, service facilities and related limits.

First, the sum of medical expenses that meet the medical insurance drug list, diagnosis and treatment items and service facilities (that is, the three major medical insurance lists) and the relevant limits of ordinary inpatients with special diseases and outpatients with major diseases. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: the national social security medical insurance application reimbursement process in 2020!

Example: Wang, a first-class insured resident, was hospitalized in a tertiary hospital on April 20 13, and incurred medical expenses of 37,000 yuan, including Class A14,000 yuan, Class B drugs of 3,000 yuan, Class A diagnosis and treatment items of10,000 yuan, Class B diagnosis and treatment items of 2,000 yuan, and medical materials of 50,000 yuan. Of the above expenses of 37,000 yuan, 3,000×10% for Class B drugs = 2,000× 20% for 300 yuan Class B medical treatment projects = 400 yuan, 2,000 yuan for medical materials exceeding the limit, and 3,000 yuan for expenses beyond the scope of medical insurance reimbursement, totaling 5,700 yuan, which does not belong to the scope of medical insurance fund reimbursement. Therefore, the medical expenses within the reimbursement scope of medical insurance fund are: class A drugs+class B drugs × (1-kloc-0/0%)+class A projects+class B projects ×( 1-20%)+ expenses within the limit of medical materials =14000+3000.

Two, the implementation of single disease or fixed lump sum settlement costs according to the single disease quota standard or fixed lump sum settlement.

Example: In June of October-March, Zhang, an insured resident, was hospitalized for surgical treatment of acute simple appendicitis in the second-class hospital of the city, and the medical expenses totaled 2,500 yuan. Because the hospital signed a single disease service agreement with the medical insurance agency, the fixed cost of acute simple appendicitis surgery is 2 100 yuan, so the medical expenses within the scope of medical insurance fund reimbursement are 2 100 yuan.

Bao Ge reminds: What is the scope of medical insurance reimbursement for serious illness and cancer in Sichuan medical insurance? Usually refers to the sum of medical expenses that meet the medical insurance drug list, diagnosis and treatment items, service facilities and related limits. It should be noted that if the medical insurance and the agency sign a single disease service agreement, the disease will be fully reimbursed.