Proportion of outpatient reimbursement for chronic diseases in residents' medical insurance

There is no deductible line for outpatient reimbursement of common chronic diseases, and the reimbursement ratio is 60%. But the maximum annual reimbursement is 3000 yuan. Patients can report at any time or regularly. Common chronic diseases include hypertension, coronary heart disease, cerebral hemorrhage and cerebral infarction recovery period, chronic ulcerative colitis, decompensated cirrhosis, diabetes, rheumatism and other diseases.

Medical insurance reimbursement categories and supporting materials:

1. Transfer for medical treatment: If it is really necessary to transfer for medical treatment, if the condition is urgent, the formalities should be completed within 7 days of transfer and admission;

2. Resettlement and work in different places: if you want to live and work in different places for more than half a year, you must go through the registration formalities in advance;

3. Medical expenses during short-term outings such as business trip, visiting relatives and traveling: ① Acute illness: providing business trip certificate, visiting relatives certificate, travel contract, air ticket to real-name registration system, etc. At the time of reimbursement; (2) outpatient maintenance treatment of chronic diseases: the medical records of Xiamen should be increased, and the measures of diagnosis and treatment should not exceed that of Xiamen;

4. Off-site delivery: hospitalization delivery expenses and reasonable prenatal and postpartum examination expenses;

5. Failures of social security system in local and urbanized areas cannot be settled in real time by credit cards: the invoices of the charging offices of medical institutions should be endorsed and stamped;

6. The social security card is reported lost or damaged, and the printing of the business card is delayed: the back of the invoice of the social security card management department is stamped for confirmation;

7. The number of outpatient visits in a single month exceeds 20: the bill must be settled by credit card and show the number of registered visits, and outpatient records must be provided;

8. Acute illness or rescue without social security card: the medical records of outpatient or inpatient should be detailed and clear enough to be identified as acute illness or rescue;

9. Off-catalogue drug expenses of retired cadres: An Approval Form for Off-catalogue Drugs of Retired Cadres should be provided and stamped with the official seal of the hospital medical insurance management department; The retired cadres entrusted by the provincial two-level charging center should provide health care certificates;

10. Enrolment status, change, change of insured unit and delay in receiving local tax data: reimbursement can be made after the local tax change is confirmed in the middle of the next month;

1 1. Medical expenses of newborns from birth: they should be insured within three months of birth and paid in time, and can only be reimbursed after receiving the money. Need a birth certificate; For the unnamed newborn at the time of expense, the name on reimbursement vouchers such as medical expense invoices, summary tables and discharge records should be the name of the mother or father followed by "son" or "daughter".

To sum up, the reimbursement rate of chronic diseases: the reimbursement rate paid by adult residents according to the low standard is 50%; The reimbursement rate for minor residents and adult residents who pay according to the high-grade standard is 60%.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.