According to the "Notice on Further Improving the Provincial Level Medical Insurance Outpatient Chronic Disease Policy" jointly issued by the Hebei Provincial Medical Security Bureau and the Hebei Provincial Department of Finance. The current provincial-level chronic disease policy will be adjusted to improve outpatient chronic disease benefits for employees covered by provincial-level basic medical insurance and those insured by 4% supplementary insurance. The "Notice" stipulates that the outpatient chronic disease policy of the provincial basic medical insurance for employees shall be improved and all persons insured by the basic medical insurance for employees at the provincial level shall be included in the scope of outpatient chronic disease management services. There are 38 types of chronic diseases for participants in the provincial employee basic medical insurance. The minimum payment limit for outpatient chronic disease medical expenses is 200 yuan. The minimum payment limit for multiple chronic diseases will not be repeated within the year. For medical expenses incurred within the policy scope that exceed the minimum payment limit, 50% will be borne by the individual and 50% will be borne by the overall fund.
What are the annual regulations for a single disease pooling fund?
The annual expenditure of the unified fund for a single disease shall not exceed the annual limit for that disease. The maximum reimbursement limit for each person suffering from two or more chronic diseases per year from the unified fund is 5,000 yuan. Outpatient chronic disease benefits for employees insured by the provincial employee basic medical insurance are paid by the basic medical insurance co-ordination fund. Outpatient chronic disease expenses are separately managed by the annual maximum limit, and are not combined with inpatient medical expenses to calculate the annual maximum payment limit of the basic medical insurance fund. It also improved the provincial outpatient chronic disease policy for 4% supplementary medical insurance participants and adjusted the number of outpatient chronic diseases for provincial 4% supplementary medical insurance participants to 38. The minimum payment limit for outpatient chronic disease medical expenses is 200 yuan. The minimum payment limit for multiple chronic diseases will not be repeated within the year. For medical expenses incurred within the scope of the policy that exceed the minimum payment limit, 40% will be borne by the individual and 60% will be borne by the overall fund. Outpatient chronic diseases are subject to annual limit management for a single disease, and the annual expenditure of a single chronic disease overall fund shall not exceed the annual limit for that disease. The 9 chronic diseases that have been recognized by the provincial-level 4% supplementary medical insurance participants in accordance with the original policy will continue to maintain the original benefits. After the implementation of the new policy, the original nine chronic diseases will no longer be accepted for application and identification. If the nine chronic diseases have been identified according to the original policy, if the same type of chronic disease is declared within the scope of the new policy, the original treatment will be automatically cancelled. Outpatient chronic disease benefits for participants in the 4% supplementary medical insurance at this level are paid by the 4% supplementary insurance fund. Outpatient chronic disease expenses are not combined with inpatient medical expenses to calculate the annual maximum payment limit of the basic medical insurance fund.
In summary, medical expenses above the minimum payment standard and below the annual maximum payment limit for outpatient chronic diseases will be reimbursed proportionally, and the outpatient overall fund will pay 50%.
Legal basis: "Social Insurance Law of the People's Republic of China"
Article 26 Benefits of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents Standards are implemented in accordance with national regulations.
Article 27 Individuals participating in the basic medical insurance for employees who have made cumulative contributions for the number of years specified by the state when they reach the legal retirement age will no longer pay basic medical insurance premiums after retirement and enjoy basic medical insurance in accordance with national regulations. Benefits; those who have not reached the number of years stipulated by the state can pay until the number of years stipulated by the state.
Article 28: Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.