Proportion of reimbursement for chronic diseases and serious diseases

The proportion of medical insurance reimbursement for serious illness and chronic disease is as follows:

1. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The expenses of outpatient hemodialysis, peritoneal dialysis and cyclosporine A after organ transplantation in patients with chronic renal failure were further increased by 10 percentage point.

2. Qifubiaozhun for Class B chronic diseases: 300 yuan. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid 80% above the deductible standard, and shall not exceed the maximum payment limit for chronic diseases within one medical year or within the validity period;

3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the two diseases identified first, and calculate the deductible for each disease separately. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

Medical insurance reimbursement process:

1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;

3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;

4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.

What items can be reimbursed by medical insurance?

1. Hospitalization: Medical insurance can guarantee hospitalization caused by illness or accident, including medical service fees, medicine fees, materials fees, examination fees, etc.

2. Outpatient treatment: Medical insurance can reimburse medical expenses for outpatient treatment, including registration fees, inspection fees, inspection fees, medicine fees, etc.

3. Physical examination: Medical insurance can reimburse medical examination expenses paid by individuals at their own expense.

It should be noted that there may be differences in different regions and policies, and the specific scope and standard of reimbursement shall be subject to local policies.

To sum up, the proportion of medical insurance reimbursement for serious illness and chronic diseases is determined according to local policies and regulations, and there may be differences in the proportion of reimbursement in different regions. Generally speaking, the reimbursement ratio of chronic medical insurance includes two aspects: the basic medical insurance payment ratio: the basic medical insurance payment ratio refers to the proportion paid by the medical insurance fund, which is generally between 70% and 80%; Personal out-of-pocket ratio: Personal out-of-pocket ratio refers to the proportion of medical expenses that individuals need to bear, generally between 20% and 30%.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.