Conditions
Participants in medical insurance
Reimbursement scope of major medical insurance
Participants with one of the following circumstances, enjoy outpatient treatment of major diseases:
1, outpatient dialysis for chronic renal failure;
2, included in the scope of payment of medical insurance for organ transplantation outpatient use of anti-rejection drugs;
3, malignant tumor outpatient chemotherapy, interventional therapy, radiotherapy or nuclide therapy;
3, outpatient chemotherapy, interventional therapy, radiotherapy or nuclide therapy.
3, malignant tumor outpatient chemotherapy, interventional therapy, radiotherapy or nuclear therapy;
4, hemophilia specialist outpatient treatment;
5, aplastic anemia specialist outpatient treatment;
6, thalassemia specialist outpatient treatment;
7, benign intracranial tumors specialist outpatient treatment
8, other major illnesses.
What are the conditions that cannot be reimbursed by the Medical Insurance for Major Diseases?
1, unauthorized treatment in non-scheduled hospitals (except for emergency rescue);
2, suffering from occupational diseases, work-related injuries or recurrence of old work-related injuries;
3, injuries caused by traffic accidents;
4, injuries caused by their own illegal;
5, food poisoning due to accidents of responsibility;
6, Suicide resulting in treatment;
7, due to medical malpractice resulting in injury;
8, according to national and municipal regulations of medical expenses should be self-care.
Handling materials
1, the employee's "medical insurance card", "major medical insurance payment card";
2, major medical expenses co-ordination fund disbursement approval form (three) (and stamped with the official seal);
3, the diagnosis of the discharge of Zhengming (emergency rescue should be issued emergency rescue diagnosis of Zhengming), the "coordinated patients with major illnesses, in-patient medical expenses settlement list", Beijing Hospitalization Fee Receipt" and "Hospitalization Fee Statement" (hospitalization reimbursement voucher);
4, special examination, special treatment or the use of expensive drugs should be issued with an approval form;
5, outpatients need to produce diagnosis Zhengming, the major disease co-ordination prescription and Beijing outpatient fee receipt;
6, transfer to a hospital for treatment should be provided by the hospital's Office of the Major Diseases Co-ordination
7. Other materials required by the medical care system for major diseases.
8, the documents reimbursement time limit, the last day of discharge or outpatient clinic shall prevail within 60 days, after which no reimbursement;
9, the implementation of a one-time reimbursement system for major medical expenses, where due to business, personal, hospitals caused by the omission of all not to make up;
10, where due to business, personal, hospitals caused by incomplete reimbursement of materials will be held back for payment.
Process
All patients with serious illnesses, once hospitalized, must as soon as possible after the diagnosis, my basic medical insurance diagnosis and treatment manuals and other materials, sent to live in the hospital medical insurance section registration, verification, so as not to affect the reimbursement of hospitalized medical expenses;
Application for outpatient reimbursement of cirrhosis and other 23 kinds of illnesses, the insured residents to hold their basic medical insurance diagnosis and treatment manuals and declare
The final review of qualified residents by the municipal health insurance agencies to organize the issuance of "Taiyuan City basic medical insurance outpatient specific disease medical card", stamped effective from July, January to enjoy outpatient chronic disease treatment.
Reimbursement ratio standard
The actual payment ratio of major medical insurance is not less than 50%
In the urban and rural residents of major medical insurance coverage, the "Opinions" pointed out that the object of major medical insurance coverage for urban residents of the medical insurance, the new rural cooperative insurance (co-operation), the scope of the coverage should be connected with the urban residents of the medical insurance, the new rural cooperative. The urban residents' medical insurance and the New Rural Cooperative shall provide basic medical protection in accordance with the policy. On this basis, the major illness insurance shall mainly provide protection for the individual's burden of the compliant medical expenses after the compensation from the urban residents' medical insurance and the New Rural Cooperative Medical Insurance in the event that the insured person suffers from a major illness and incurs high medical expenses. In addition, the level of protection of major medical insurance to strive to avoid the occurrence of urban and rural residents of family catastrophic medical expenditure as the goal, a reasonable determination of the compensation policy of major medical insurance, the actual payment ratio of not less than 50%; according to the high and low medical expenses to formulate the payment ratio, in principle, the higher the higher the medical costs of the higher payment ratio.