Taking Wuxi as an example, the reimbursement policy for chronic outpatient service: First, it guarantees diabetes, hypertension (grade II and III), malignant tumor, chronic hepatitis (except hepatitis A), stroke (including cerebral infarction, cerebral hemorrhage, sequelae of cerebrovascular accident), chronic nephritis (including chronic renal insufficiency), systemic lupus erythematosus, tuberculosis (active stage) and chronic obstructive pulmonary disease (including chronic bronchitis, emphysema, bronchus). Coronary heart disease (angina pectoris, myocardial infarction), cardiomyopathy (dilated and hypertrophic), rheumatic heart disease, chronic heart failure, Parkinson's disease, Parkinson's syndrome, ankylosing spondylitis, epilepsy, scleroderma (systemic sclerosis), myasthenia gravis, hyperthyroidism (primary), inflammatory bowel disease (ulcerative colitis, Crohn's disease), motor neuron disease (MND) and idiopathic. Hereinafter referred to as chronic diseases. Second, the scope of protection to participate in medical insurance for employees with chronic diseases, in line with the basic medical insurance coverage of drugs and treatment project costs to give corresponding protection. Third, the level of protection For the compliance medical expenses incurred by patients with chronic diseases, after the employee's personal medical insurance account is used up, the on-the-job individual pays more than 500 yuan, and the fund pays 70%. The maximum annual fund payment limit is 3,500 yuan; Retirees pay more than 300 yuan, 85% is paid by the fund, and the maximum annual fund payment limit is 4,000 yuan. At the same time, the insured with two or more chronic diseases will increase the maximum payment limit of the fund 1000 yuan during the year.

Legal basis:

Article 1 of the Notice of Wuxi Municipality on Further Improving the Medical Security Policy for Chronic Diseases in Wuxi Medical Insurance Outpatients (Wuxi Medical Insurance Service [2020] No.41) stipulates that diabetes, hypertension (Grade II and III), malignant tumor, chronic hepatitis (except hepatitis A), stroke (including cerebral infarction, cerebral hemorrhage and sequelae of cerebrovascular accident) and chronic nephritis (including chronic renal failure) should be guaranteed. Tuberculosis (active stage), chronic obstructive pulmonary disease (including chronic bronchitis, emphysema, bronchial asthma), chronic respiratory failure, liver cirrhosis, rheumatoid arthritis, coronary heart disease (angina pectoris, myocardial infarction), cardiomyopathy (dilated, hypertrophic), rheumatic heart disease, chronic heart failure, Parkinson's disease, Parkinson's syndrome, ankylosing spondylitis, epilepsy, scleroderma (systemic sclerosis), etc. Hyperthyroidism (primary), inflammatory bowel disease (ulcerative colitis, Crohn's disease), motor neuron disease (MND), idiopathic inflammatory myopathy (referring to polymyositis and dermatitis), chronic inflammatory demyelinating polyneuropathy (chronic Guillain-Barre syndrome). Hereinafter referred to as chronic diseases. Article 2 of the Notice of Wuxi Municipality on Further Improving the Medical Security Policy for Chronic Diseases in Medical Insurance Outpatients of Workers in Our City (xi Medical Insurance Service [2020] No.41) stipulates that the scope of protection provides corresponding protection for the expenses of drugs and diagnosis and treatment items for employees with chronic diseases who are covered by medical insurance and meet the coverage of basic medical insurance. Article 3 of the Notice of Wuxi Municipality on Further Improving the Medical Security Policy for Chronic Diseases in Medical Insurance Outpatients in Wuxi City (Wuxi Medical Insurance Service [2020] No.41) stipulates that if the medical expenses incurred by patients with chronic diseases are within the scope of security, after the employees' personal medical insurance accounts are used up, the employees on the job will pay more than 500 yuan, and the fund will pay 70%, with the maximum annual fund payment limit of 3,500 yuan; Retirees pay more than 300 yuan, 85% is paid by the fund, and the maximum annual fund payment limit is 4,000 yuan. At the same time, the insured with two or more chronic diseases will increase the maximum payment limit of the fund 1000 yuan during the year.

People's Republic of China (PRC) Social Insurance Law Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations. Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.