Insurance editors to help you answer, more questions can be answered online.
First, you can apply for the identification of outpatient chronic diseases after participating in the urban residents' health insurance.
Second, 1, the scope of outpatient chronic diseases
①, coronary atherosclerotic heart disease (excluding insidious);
②, primary hypertension (limited to people over 50 years of age);
3, diabetes mellitus (limited to those who combine the following chronic complications: microvascular disease, diabetic encephalopathy, nephropathy, diabetic necrotic foot and retinopathy phase II (or more).
2, outpatient chronic disease review and appraisal criteria
3, reporting and approval procedures: the above chronic diseases of the insured residents by their own application, and provide the following information to the community labor security workstations: a copy of the hospitalization medical records, the original outpatient medical records, the original inspection report card, CT report card, coronary angiography report card, a copy of the rescue medical records, the "residents' medical insurance", ID card and a copy and the "residents' medical insurance". Guarantee", ID card and photocopy and a recent 2-inch color photo of oneself. The community labor security workstation health insurance coordinator uniformly fill out the "urban residents basic medical insurance outpatient chronic disease application appraisal form", reported to the district and county medical insurance agency.
District and county medical insurance agencies based on outpatient chronic disease review and appraisal standards, the reported medical records and related information for review, the condition of the insured residents in line with the outpatient chronic disease standards, uniformly fill out the "urban residents' basic medical insurance outpatient chronic disease identification form", reported to the municipal medical insurance agencies for review. Based on the results of the review, the municipal health insurance agency will determine the list of insured residents who are entitled to the outpatient chronic disease subsidy and feedback the list of persons to the insured residents at each level.
4, medical procedures: approved and recognized as enjoying outpatient chronic disease subsidies for the insured residents, can be in the health insurance designated medical institutions (including designated community health service institutions) for medical treatment. At the same time, the treatment plan prescribed by the physician of the designated medical institution will be recorded in the outpatient medical record. Urban residents treatment of chronic disease medication is limited to the "local basic medical insurance and workers' compensation insurance drug list" treatment of drugs must be consistent with their own treatment program, shall not be issued large prescriptions or the use of out-of-scope drugs.
5, the cost of settlement: recognized as enjoying outpatient chronic disease subsidies for the insured residents, at the end of June each year, will be recognized to enjoy the treatment of outpatient prescriptions, outpatient bills and laboratory tests, inspection, treatment costs bills and other related materials submitted to the community labor security workstations, the community labor security workstations reported to the district and county health insurance agencies after sorting and summarizing. The district and county medical insurance agencies will audit the medical expenses according to the provisions of Article 18(4) of the Interim Measures (if the accumulated medical expenses for outpatient treatment of chronic diseases incurred in a designated medical institution exceeds RMB 350 yuan in a year, the excess will be paid by the integrated fund at a rate of 50%, and the maximum payment limit of the integrated fund will be RMB 2,000 yuan), and the medical expenses will be settled after the municipal medical insurance agency reviews and confirms the settlement of the expenses. Settlement. The district and county medical insurance agencies will pay for the chronic disease subsidy.