What can't be reimbursed for hospitalization expenses and medical insurance?

Chronic diseases are diseases that must be treated for a long time, so medical insurance has special provisions for chronic diseases. First of all, before reimbursement, you must submit an appraisal report and apply for confirmation of chronic diseases, otherwise reimbursement is impossible. 3000 yuan in medical insurance can be reported, and only three chronic diseases can be reported at most, which cannot exceed the prescribed standards.

1. What is the reimbursement rate of chronic medical insurance?

The reimbursement standard for chronic diseases is: the annual deductible standard is 300 yuan, which meets the requirements of overall disease treatment, 80% for urban workers and 50% for urban residents above the deductible standard. A medical year shall not exceed the maximum payment limit for chronic diseases.

2. What are the chronic diseases reimbursed by medical insurance?

25 kinds of chronic diseases include: malignant tumor, chronic renal insufficiency, aplastic anemia, rheumatoid disease, chronic active hepatitis, chronic inflammation, tuberculosis, intestinal adhesion, cerebrovascular accident recovery period, decompensated cirrhosis, chronic lung disease, chronic cardiac insufficiency, arrhythmia, coronary heart disease, Parkinson's disease, hypertension, diabetes, chronic prostatitis, benign prostatic hyperplasia, psychosis, leprosy and lupus erythematosus.

Three, chronic disease outpatient medical treatment:

Within one year (September 1 to August 3 1), the disease surpassed 500 yuan once, 700 yuan twice and 900 yuan three times. Within the scope of medical insurance, the medical insurance fund is reimbursed at 60%, and the annual cumulative reimbursement limit is 3,000 yuan. Outpatient reimbursement for serious illness: malignant tumor, anti-rejection treatment after organ transplantation, and diseases requiring long-term hemodialysis. If the outpatient medical expenses exceed the deductible line, within the scope of medical insurance, the medical insurance fund will pay 70%, which will be combined with the hospitalization expenses of the current year and will not exceed the maximum limit stipulated by the insured residents.

Four, chronic disease reimbursement process:

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

2, will be more than two hospital diagnosis proof materials submitted to the social security center, after the expert committee appraisal audit, for chronic disease card calendar. The expert committee of chronic disease identification is held once every quarter, and the expenses required for identification shall be borne by individuals or units.

3, patients in the designated hospital outpatient department to see a doctor to buy medicine.

4. Within the specified time, go to the social security center to reimburse the medical expenses for chronic diseases, and at the same time file the list of medical expenses for outpatient clinics for chronic diseases together with prescriptions, invoices, chronic disease certificates, medical records and various inspection reports. It should be noted that when applying for reimbursement of chronic diseases, each person can declare up to three chronic diseases.

Legal basis:

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

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.