1, various malignant tumors (non-radiotherapy and chemotherapy, radiotherapy and chemotherapy);
2. Anti-rejection therapy after organ transplantation;
3. Chronic renal insufficiency;
4. Chronic obstructive pulmonary disease;
5. Chronic congestive heart failure;
6, chronic active hepatitis consolidation period;
7. Liver cirrhosis;
8. Diabetes;
9. Coronary heart disease;
10, mental illness (only schizophrenia and paranoid mental disorder);
1 1, active period of pulmonary tuberculosis;
12, hemophilia;
13, psoriasis;
14, hypertension (high risk population);
15, hyperthyroidism;
16, sequelae of cerebrovascular disease;
17, Parkinson's syndrome;
18, systemic lupus erythematosus;
19, aplastic anemia;
20. Severe and moderate thalassemia;
2 1, rheumatoid arthritis.
Extended data:
Outpatient specific items of basic medical insurance for urban workers and settlement of medical expenses.
(1) Types and scope of specific outpatient items
1, emergency observation: it mainly includes acute severe trauma, brain trauma, fracture, dislocation, laceration, burn, acute abdominal pain, sudden high fever, acute bleeding, vomiting blood, signs of internal bleeding, diarrhea, severe dehydration, shock, convulsion or coma, and foreign bodies in ears, nose, larynx, eyes, trachea, bronchus and esophagus.
2. Family sickbed: The treatment scope mainly includes patients with sequelae of cerebrovascular accident, advanced malignant tumor, chronic obstructive pulmonary disease, senile brain atrophy, recovery period of fracture, cardiac insufficiency caused by chronic cardiovascular disease, urinary retention requiring indwelling catheter, chronic failure and chronic uremia caused by various reasons.
(two) the proportion of outpatient payment for specific projects.
After examination and approval, the specific outpatient items shall be paid by the overall fund and the insured individuals in proportion, and the standards are as follows:
1. Outpatient and emergency observation: The payment method of medical expenses incurred by the insured during each observation in the emergency observation room of the designated medical institution is the same as that of hospitalization.
2. Family sickbed: for on-the-job employees, 20% will be paid by individuals within 2 months, and 80% will be paid by the overall fund; From the third month, individuals pay 30% and the overall fund pays 70%. For retirees, the individual pays 10% within 2 months, and the overall fund pays 90%; From the third month, individuals pay 15%, and the overall fund pays 85%.
3. Out-patient serious illness: The insured shall submit an application for out-patient serious illness according to regulations, and after being evaluated by designated medical institutions (above Grade II), he shall enjoy medical treatment for out-patient serious illness from the date of application:
(1) Approved organ transplantation, chemotherapy, radiotherapy and anti-rejection treatment after dialysis of severe uremia: employee 15%, retiree 8%, and overall fund 85% and 92% respectively.
(2) Except for chemotherapy, radiotherapy, anti-rejection therapy after organ transplantation and dialysis for severe uremia, the employees will pay 20% for the part of the limited drugs used within 1 month that exceeds 300 yuan/month, and the overall fund will pay 80%; Retirees pay 10%, and the overall fund pays 90%.
(3) Outpatient serious illness co-ordination payment treatment is valid for one year, and outpatient serious illness treatment card is implemented on a one-year trial basis.
Notice of Nanning Municipal People's Government-Nanning Municipal People's Government on printing and distributing the measures for basic medical insurance for urban workers in Nanning