The expenses reimbursed for outpatient special diseases include the following:
1. Medical service costs: These include the costs directly related to the treatment of the disease, such as diagnosis and treatment fees, examination fees, laboratory fees, medicine fees and material fees, etc., incurred during the treatment of outpatient special diseases in medical institutions.
2. Pharmaceutical expenses: For outpatient special disease patients who need to take specific medicines for a long time, such as hypertension, diabetes, malignant tumors and other diseases, the cost of medication is usually also within the scope of reimbursement.
3. Treatment equipment and consumables costs: If specialized medical equipment or single-use medical consumables are used in the treatment process, these costs may also be included in the reimbursement.
4. Expenses for special medical services: For example, expenses for special medical services for specific diseases, such as rehabilitation therapy, psychological counseling, physiotherapy, etc., may be reimbursed to varying degrees according to local policies.
5. Outpatient expenses before and after hospitalization: For some diseases that require hospitalization, some regional policies may also include outpatient expenses related to a period of time before and after hospitalization.
It is important to note that the specific rules for outpatient reimbursement may vary by region and type of health insurance. The reimbursement rate, the threshold and the individual's out-of-pocket portion will all affect the actual amount of reimbursement. In addition, there may be separate reimbursement policies or limits for certain high-value drugs or specialized medical services.
In summary, the Outpatient Specialty mainly reimburses medical expenses directly related to the treatment of outpatient special diseases, including medical services, medicines, therapeutic equipments and consumables, special medical services, as well as outpatient expenses before and after hospitalization.
Legal basis:
The Social Insurance Law of the People's Republic of China
Article 2
The state establishes a social insurance system of basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., and guarantees the citizens' rights to obtain material assistance from the state and society according to the law in case of old age, sickness, industrial injury, unemployment and childbirth. rights.