How to reimburse hospitalization for special diseases?

Provisions for hospitalization reimbursement for special diseases are as follows:

1, the applicant takes the information to the medical insurance center in the district where the insured unit is located. Flexible employees directly submit the information to the medical insurance center of the insured place.

2, the insured person in the designated medical institutions within the jurisdiction of the medical expenses, with social security card direct settlement. The medical expenses incurred by the insured in non-designated medical institutions or designated medical institutions outside the city shall be paid by the insured himself, and can be reimbursed by the local social security institution with the required information.

The special diseases of temporary residents' medical insurance clinics are as follows: category I: malignant tumor, hemodialysis, hemophilia and liver and kidney organ transplantation. The second category: schizophrenia, affective disorder and aplastic anemia.

The qifubiaozhun for special diseases in urban residents' medical insurance outpatient service is 500 yuan, and the specific settlement method: the settlement method of special diseases in outpatient service is similar to that in hospitalization, that is to say, the proportion of hospitalization reimbursement is enjoyed; 70% of the expenses for special diseases in the second-class outpatient service shall be reimbursed within the scope of policies stipulated by drugs and diagnosis and treatment projects, and the maximum subsidy limit in a settlement year is 2000 yuan.

Insured persons with special diseases can apply to the handling window of the social security center with the application form for outpatient special diseases, discharge records, outpatient medical records and related inspection reports issued by designated hospitals at or above the second level, and the related expenses incurred after the application is approved can be reimbursed according to the policy.

Hospitalization special insurance can be reimbursed, with the same proportion of hospitalization reimbursement for major and special diseases and unlimited reimbursement amount. Only out-patient clinics prescribe a limited number of drugs.

Take living in a tertiary hospital as an example. Regardless of serious diseases, about 80% of the basic medical insurance for urban workers can be reimbursed, and about 60% of the basic medical insurance for urban residents can be reimbursed. The new rural cooperative medical system (NCMS) can be reimbursed about 70%, and it can be reimbursed about 15% after returning to the township twice.

Qifubiaozhun: The Qifubiaozhun for chronic diseases in designated community health service institutions is 200 yuan, and the Qifubiaozhun for designated specialized hospitals is 200 yuan. On the Qifubiaozhun, the medical expenses below the annual maximum payment limit for chronic diseases in outpatient department are reimbursed in proportion, and the outpatient co-ordination fund pays 50%. If there are two or more chronic diseases, the payment limit shall be determined according to the principle of high or low.

legal ground

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.