I. Types of Special Disease Reimbursement

21 diseases including liver cirrhosis, mental illness, malignant tumor, hepatomegaly, hepatitis C, Parkinson's disease, rheumatoid arthritis, coronary artery disease, hypertension III, diabetes mellitus, renal dialysis, post-renal transplantation, chronic heart failure, chronic renal insufficiency, systemic lupus erythematosus, breast cancer (endocrine therapy), post-hepatic transplantation, hematopoietic stem cells Post-transplantation, prostate cancer (endocrine therapy), epilepsy, bladder tumor (perfusion therapy) and 21 other diseases.

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The reimbursement policy of special disease outpatient clinic

1, reimbursement rate

Employee medical insurance: within a medical insurance year, the starting line of 400 yuan for outpatient clinic of special diseases, and reimbursement rate of the medical expenses in line with the prescribed scope of treatment is the same as that of the general hospitalization treatment.

Urban and rural residents' medical insurance: within one medical insurance year, the starting line for outpatient treatment of special diseases is 400 yuan, and the reimbursement rate of medical expenses in accordance with the scope of treatment is the same as that of general hospitalization.

2. Reimbursement formula:

Total outpatient special expenses within a treatment period - all out-of-pocket expenses - starting standard - individual first out-of-pocket portion)＊reimbursement ratio

3. Reimbursement process of special illnesses

1. Submit the above materials to the insured Flexibly employed persons will submit the above materials directly to the medical insurance center of the district in which they are insured. The monthly declaration of special diseases is from 1 to 20.

2. On the 23rd-24th of each month (holidays are postponed), the declared person should call the participating health insurance center or go directly to the unit or health insurance center to know the address of the examination hospital and the date of the examination, and arrive at the designated hospital at 8:30 a.m. on the examination day.

3. On the day of the examination, the declarant should bring along the original outpatient medical records related to the application for the special disease category (medical record information within 2 years from the date of onset of the disease), a copy of the inpatient medical records (which must be stamped by the hospital), the originals of the examination information and the original films (e.g., CT, MRI, coronary artery angiograms), as well as the original ID card and the medical insurance certificate.

4. Participants declaring diabetes and cirrhosis of the liver (loss of compensation) need to go to the hospital on an empty stomach for examination (bring your own breakfast).