The outpatient treatment fee for special diseases and the hospitalization medical expenses paid by the overall fund are calculated together, and the maximum payment limit within one year is 50 thousand yuan.
Medical reimbursement policy
1. Patients with chronic diseases can choose 1-2 designated hospitals for treatment (only one hospital at the same level can be selected, and the deductible line and reimbursement ratio are implemented according to the standards of high-grade hospitals), and the reimbursement ratio and deductible line of chronic diseases of Class I and II are implemented according to the hospitalization standards of the selected treatment hospitals; There is no deductible for Class III diseases, and the reimbursement rate is 70%.
2. If the same insured patient suffers from two or more chronic diseases, the annual quota shall be implemented according to the diseases with the highest quota among the chronic diseases, and several drugs for chronic diseases shall be included in the scope of reimbursement.
3. When seeking medical treatment, the patient needs to provide his/her medical certificate, ID card and application form for identification of chronic diseases and special diseases of urban and rural residents in Xixiang County.
4. Patients who take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumors, hemodialysis for renal insufficiency, and organ transplantation, who choose family beds for hospitalization, will no longer enjoy reimbursement for special chronic diseases in outpatient clinics.
5. Outpatient expenses for chronic and special diseases generated by designated medical institutions in different places shall be reimbursed in the general hospital of the jurisdiction according to the regulations with the original outpatient medical records, residence certificates, drug prescriptions and invoices (when applying for the treatment of chronic and special diseases, choose a hospital for treatment in different places and a general hospital in the jurisdiction).
6. During hospitalization, no reimbursement expenses for outpatient chronic diseases shall occur, and no bid for outpatient chronic diseases shall be made.
7. Patients with chronic diseases and special diseases can't prescribe drugs for more than 3 months at most. Medical insurance will not pay for outpatient medical expenses beyond the limited disease treatment plan and prescription dose range.
8. Reimbursement of special drugs negotiated by the state needs to issue a special drug approval form negotiated by the state, and medical insurance will not pay the drug expenses without approval.
9. During the year, if the outpatient reimbursement expenses of patients with chronic diseases and special diseases reach the approved disease quota standard, and the accumulated compliance expenses of individuals exceed the deductible line of serious illness insurance, they will be reimbursed by serious illness insurance.
Non-reimbursement scope
1. Outpatient medical expenses of those who fail to pass the appraisal.
2. Outpatient medical expenses incurred before inspection and filing.
3. Medical expenses not incurred in the selected treatment institution.
4. Outpatient medical expenses beyond the scope of the treatment plan, as well as the audit amount and prescription dose.
5. Outpatient medical expenses that should be borne by public health.
6. Other expenses beyond the scope of drug use for diseases have been determined.