For some particularly expensive major diseases, China will establish a supplementary medical insurance reimbursement system, on the basis of the basic medical insurance reimbursement, reimbursement is again given, requiring the actual reimbursement ratio of not less than 50%. Working employees hospitalization medical reimbursement reimbursement ratio medical insurance hospitalization, the total cost in addition to the out-of-pocket expenses, category B costs first after paying 10%, more than the hospital medical insurance threshold fee, enjoy the proportion of co-ordination of payment hospital level of different threshold fee is different, enjoy the co-ordination of the payment of the proportion is also different. The proportion of employee health insurance is more than 80% (82%/84%/87% in Wuhan), and the proportion of resident health insurance is about 70% (80%/65%/50% in Wuhan).
The process of reimbursement of medical insurance for major diseases:
1. After the hospitalization of patients with major diseases, they must send the diagnostic certificate, their basic medical insurance diagnosis and treatment manuals and other materials to the medical insurance department of the hospital they are staying in for registration and verification as soon as possible, so as to avoid affecting the reimbursement of the hospitalized medical expenses.
2. Outpatient medical expenses need to be reimbursed in accordance with the stipulated time. Outpatient reimbursement for 23 diseases, including cirrhosis, is available for two times a year, while seven diseases, including leukemia, are available for one time at the end of each quarter.
A. To apply for outpatient reimbursement for 23 diseases such as liver cirrhosis, insured residents should hold their basic medical insurance diagnosis and treatment manuals as well as the materials required for the declared diseases to fill out the relevant forms for preliminary examination at the medical insurance section of the designated hospitals in May and November every year; the designated hospitals will submit the information of the qualified residents to the urban medical insurance agencies for examination and approval. The final review of qualified residents by the municipal health insurance agencies to organize the issuance of "xx city basic medical insurance outpatient specific disease medical card", stamped and effective, from July, January to enjoy the outpatient chronic disease treatment.
B. To apply for outpatient reimbursement of leukemia and other 7 diseases, the insured resident should hold his/her own basic medical insurance treatment manual and bring the materials required for the application of the disease to the medical insurance department of the first hospital of his/her choice at the end of each quarter for the first examination, and then fill in the relevant forms after passing the first examination. Outpatient chronic disease patients who meet the requirements are issued with the "XX City Basic Medical Insurance Outpatient Specific Disease Medical Card" and enjoy the relevant treatment according to the corresponding time.
Taking uremia as an example, patients are first hospitalized. For the reimbursement of hospitalization expenses, the regulations are as follows: the reimbursement starts at over 200 yuan in the first A hospital, and the reimbursement rate in line with the policy is 85%; the reimbursement starts at over 400 yuan in the second A hospital, and the reimbursement rate in line with the policy is 70%; and the reimbursement starts at over 800 yuan in the third A hospital, and the reimbursement rate in line with the policy is 60%. "This reminds patients to look at the hospital level when choosing a hospital." Taiyuan City medical lifting zhu therapy insurance management service center, the general hospitalization of ordinary patients with uremia (second A) need to spend more than 20,000 yuan, while the late kidney dialysis will cost nearly 80,000 yuan, a total of **** about 100,000 yuan. These medical costs, the total **** of urban residents health insurance can be reimbursed about 65,000 yuan, their own responsibility for about 35,000 yuan.
Legal basis: "The Chinese people*** and the State social security card management measures" Article 6 of the issuance of social security cards in the region (hereinafter referred to as the card-issuing region) should establish standardized human resources and social security business processes, the various businesses have a strong integrated coordination between the effective application of social security cards can be guaranteed. In the same positive wow, the following technical conditions shall also be available: (1) establishment of business management systems, databases, and information networks suitable for card usage that provide back-end support for the application of social security cards; (2) technical strength to support the management and application of social security cards, including personnel, equipment, etc., and to be able to quickly complete the layout of the system for the application of social security cards; (3) formulation of standardized and feasible implementation plans, including application design program, cost solution, information collection program and specific issuance program, etc.; (iv) establish a scientific and perfect social security card issuance and management system and clear internal control procedures, and formulate a plan to deal with emergencies; (v) other conditions stipulated by the Ministry of Human Resources and Social Security.