1. Contents of special policy adjustment:
1. At present, there are 28 kinds of medical insurance for special diseases and 44 kinds of medical insurance for urban and rural residents in Changsha. After adjustment, the number of special diseases in Changsha's basic medical insurance increased to 45, including 42 urban workers and 45 urban and rural residents (phenylketonuria, rehabilitation of children with cerebral palsy and pritt-Weil syndrome are more common diseases than urban workers' medical insurance), and the rare disease "primary immunoglobulin deficiency" announced by the state was included in the coverage.
2. The reimbursement rate of urban and rural residents' special medical insurance will be increased from 50% to 70%, and the personal out-of-pocket burden of urban and rural residents' special diseases 4 1 outpatient expenses will be reduced by 20%. Among them, the maximum payment limit for phenylketonuria (PKU) is raised to 1 1,000 yuan/month (limited to 0- 14 years old), the maximum payment limit for tetrahydrobiopterin deficiency (BH4D) is raised to 1 month, and the payment limit for special diseases such as schizophrenia and affective psychosis is raised to 500 yuan/month.
3. Multi-disease insured patients can claim to enjoy the special treatment of three diseases at most at the same time, and the treatment is paid according to A, B and C. The payment limit of "special outpatient" insured persons who enjoy the treatment of second-class diseases is increased by 1000 yuan/year on the basis of the payment limit of first-visit diseases, and the payment limit of third-class diseases is increased by 2000 yuan/year on the basis of the payment limit of first-visit diseases. The payment standard is high and low. The payment limit will be calculated together and paid monthly. Those who exceed the limit will not be paid.
4. Except for ten special diseases such as outpatient rehabilitation treatment of malignant tumor, outpatient radiotherapy and chemotherapy of malignant tumor, dialysis treatment of uremia, anti-rejection treatment after transplantation (kidney, liver, heart and hematopoietic stem cells), chronic active hepatitis, tuberculosis, multiple myeloma, chronic hepatitis C, advanced cachexia of malignant tumor (family sickbed) and vegetative state (family sickbed), other special diseases will be automatically treated according to the original treatment temporarily.
2 special disease reporting procedures and time:
1, application materials:
(1) The copy of the patient's hospitalization information in the past six months in the medical record room on the first floor of the administrative building of our hospital (stamped with the official seal of the medical record room).
(2) Bring my original ID card.
(3) Provide the original medical records of my outpatient service for 3 to 5 years, the original report of abnormal health examination or the medical records of hospitalization (tumor, endovascular stent and reexamination are not needed).
(4) Two 1 inch color photos were submitted by the medical insurance insured patients in Hunan Province when handling the special work, and the 1 inch color photos were taken by the medical insurance insured patients in Changsha when receiving the special results.
(5) Those who review or change the disease need to carry a special red book, and those who increase the disease need to provide a copy of the special medical record that has been audited and stamped.
2. Application time: Changsha medical insurance insured patients can apply every month 1kloc-0/- 10/0 on normal working days, and Hunan medical insurance insured patients can apply every quarter (every year1,April, July,10)10 on normal working days.
3. Initial evaluation of outpatient information of special diseases shall be conducted by designated assessors, reviewed by the medical insurance department of the hospital, and then reviewed by the medical insurance bureau, and the evaluation results shall be fed back to the initial evaluation hospital the next month.
4. Scope of application of special diseases in our hospital: Changsha medical insurance and Hunan medical insurance insured patients.
Insured patients in Changsha County, Wangcheng District, Liuyang City and Ningxiang City need to go back to the insured places to apply for outpatient special diseases.
5. Medical insurance patients in Changsha must bring red special books and social security cards when they see a doctor. Medical insurance patients in Hunan province must bring blue special books and ID cards to see a doctor. After prescribing the medicine, they will go to window 6 of the clinic to keep accounts.