Proportion of reimbursement for chronic diseases in Wuhan social security

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According to a series of latest policies issued by the state, China will establish a supplementary medical insurance reimbursement system for some particularly expensive serious diseases, which will be reimbursed again on the basis of basic medical insurance reimbursement, and the actual reimbursement ratio is required to be no less than 50%. In-service employees' reimbursement rate for hospitalization medical insurance hospitalization, except for the self-funded part and the self-paid 10% of class B expenses, the part exceeding the hospital medical insurance deductible line enjoys the proportion of overall payment, and the proportion of overall payment is different at different hospital levels. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan).

Medical insurance reimbursement process for major diseases

All seriously ill patients, once hospitalized, must send the medical certificate, my basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department of the hospital for registration and verification as soon as possible, so as not to affect the reimbursement of hospitalization medical expenses.

In addition to hospitalization expenses, it is outpatient medical expenses. In order to successfully reimburse outpatient medical expenses, it is necessary to apply for reimbursement according to the prescribed time. There are two outpatient reimbursement opportunities at the end of each quarter for 23 diseases such as liver cirrhosis and 7 diseases such as leukemia.

To apply for outpatient reimbursement for 23 diseases such as liver cirrhosis, the insured residents should go to the medical insurance department of the designated hospital to fill in the relevant forms in May and June 165438+ 10 every year for preliminary examination. Designated hospitals will report the information of insured residents who have passed the preliminary examination to the urban medical insurance agency for review. The insured residents who finally pass the examination and approval shall be organized by the urban medical insurance agency to issue the Medical Certificate of Specific Diseases in the Basic Medical Insurance Outpatient Department of Taiyuan City, which will take effect after being sealed, and they will enjoy the treatment of chronic diseases in the outpatient department from July and June of 5438+ 10.

To apply for outpatient reimbursement of seven diseases, such as leukemia, the insured residents need to hold their own basic medical insurance diagnosis and treatment manual, and bring the materials needed for applying for diseases to the medical insurance department of the first-visit hospital for preliminary examination at the end of each quarter, and fill in the relevant forms after passing the preliminary examination. Issue the "Taiyuan Basic Medical Insurance Outpatient Specific Disease Medical Certificate" to eligible outpatients with chronic diseases, and enjoy relevant treatment according to the corresponding time.