1, reimbursed in proportion to hospitalization payment.
Malignant tumor (radiotherapy and chemotherapy), in Heyuan city, the basic medical insurance designated secondary and tertiary medical institutions emergency stay in hospital for observation (emergency, critical illness, reasons to be investigated, need to stay in hospital for observation), according to the outpatient specific disease management reimbursement, malignant tumor (radiotherapy and chemotherapy) is not limited.
2, according to the proportion of outpatient payment reimbursement.
Malignant tumor (non-radiotherapy and chemotherapy) must be treated in designated secondary and tertiary medical institutions, and the payment limit for malignant tumor (non-radiotherapy and chemotherapy) is 6000 yuan/year.
3. Special circumstances.
Those who suffer from more than two (including two) specific diseases and meet the reimbursement of outpatient medical expenses for specific diseases shall enjoy the treatment of outpatient specific diseases during the year and pay according to the highest standard of one disease. If the insured person is hospitalized during the period of enjoying specific outpatient medical insurance benefits, he cannot enjoy the outpatient medical insurance benefits of specific diseases during his hospitalization.
Expense reimbursement method:
1. Not settled immediately in the designated medical institution. Medical expenses shall be paid in advance by the insured person, and within two months, the receipt of outpatient medical expenses, the list of medical expenses (or the original prescription) and the Application Form for Specific Diseases of Basic Medical Insurance for Urban and Rural Residents in Heyuan City, the social security card, the copy and original of the ID card shall be submitted to the medical insurance agency for urban and rural residents for reimbursement.
2, instant settlement in designated medical institutions. The insured person holds the Application Form for Specific Diseases of Urban and Rural Residents' Basic Medical Insurance Outpatient in Heyuan City, and the copy and original of social security card and ID card to go through the accounting procedures in designated medical institutions.
For those who have gone through the accounting procedures, the part paid by the medical insurance fund for urban and rural residents shall be settled by the designated medical institutions and the social insurance fund management bureau in accordance with the relevant provisions, and individuals only need to pay the personal burden of outpatient medical expenses.
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