Reimbursement standard of chronic disease medical insurance:
1. Outpatient medical expenses incurred by patients with chronic diseases of category A in accordance with the regulations will be paid by the coordinated fund at 85%. The outpatient hemodialysis cost, peritoneal dialysis cost and the cost of taking cyclosporine A after organ transplantation for patients with chronic renal failure in the stage of renal failure will be increased by ten percentage points on the basis of the above;
2. Starting line standard for chronic diseases of category B: 300 yuan. The outpatient medical expenses incurred by patients with Class B chronic diseases in accordance with the regulations shall be paid at 80% of the portion above the starting line standard, and the maximum payment limit for chronic diseases shall not be exceeded in a medical year or within the validity period;
3. Participants can be recognized with two Class B chronic diseases at the same time, and the management of the two diseases shall be based on the first recognized, and the starting line shall be calculated separately for each disease type. The management of the identification of chronic diseases and the maximum payment limit will be adjusted by the human resources and social security department in due course according to the income and expenditure situation of the integrated fund. The criteria, rules and procedures for the identification of chronic diseases will be formulated separately by the municipal human resources and social security administration.
The process of reimbursement for medical insurance in a different place:
1. Those who seek medical treatment in a different place need to go through the approval of the relevant departments first. The approval location for the relocation is: the participating unit or street social security is located in the district and county medical insurance center. After applying for the relevant approval sheet, fill in the relevant content. Bring the relevant documents to the medical insurance department of the hospital in the other place for stamping. Then return the relevant approval sheet to the application of the local agency for approval;
2, the approval of the period of time is usually one year, specifically that is, the person from the date of the start to the day of the second year. It is not possible to change within one year. If the approval period has expired, the party still in the off-site will need to go to the relevant departments for re-approval. It is essential for those who are in a foreign country to choose a hospital in the foreign country, and the rules on how many hospitals can be chosen by those who are seeking medical treatment vary from region to region. Generally, you can choose two to three;
3, the people who are essential to encounter the foreign reimbursement of things, the relevant people need to go to the outpatient clinics, hospitals issued receipts, lists, prescription bottoms, details, medical insurance manuals, diagnostic proof of the case, the more detailed, the better. At the same time, you should not forget to issue a certificate of registration of the hospital you are attending, in order to facilitate the employer, the social security office, the district and county health insurance centers to carry out statistical summaries and audit and settlement of the work;
4, the person concerned in the designated hospitals in other places in the medical expenses incurred by the relevant reimbursement documents will be mailed back to the original city for reimbursement, but also allow family members to reimbursement of the city of the original help. The criteria for reimbursement will still be in accordance with the rules of the city, and the money can be claimed by family members or by setting up your own account.
In summary, the reimbursement rate for Category A, B and C drugs: 100% for Category A; 90% for Category B; and 0% for Category C, which means that you will have to pay for it yourself. The expenses incurred by the basic medical insurance participants for the use of the drugs in the "Drug List" in the "Class A List" will be paid in accordance with the provisions of the basic medical insurance. Expenses incurred for drugs in the "Category B List" are paid by the insured person at a certain percentage of his/her own expense, and then according to the provisions of the basic medical insurance. Category C is borne by the individual.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, and standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.