In p>223, the proportion standard of medical insurance reimbursement for chronic diseases is as follows:

1. The outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The outpatient hemodialysis expenses, peritoneal dialysis expenses and the expenses of taking cyclosporine A after organ transplantation for patients with chronic renal failure at renal failure stage were further increased by 1 percentage points.

2. The deductible standard for chronic diseases of Class B: 3 yuan. The outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid by 8% above the deductible standard, and the maximum payment limit for chronic diseases shall not be exceeded within one medical year or within the validity period;

3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the first identified two diseases, and calculate the deductible line for each disease separately. The identification and management of chronic diseases and the maximum payment limit will be adjusted by the human resources and social security department according to the income and expenditure of the overall fund. Criteria, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

Medical insurance reimbursement process:

1. Confirm the reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the reimbursement scope of medical insurance;

2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other related materials;

3. Go to the social security department for reimbursement: submit relevant materials to the local social security department for reimbursement of medical insurance;

4. Waiting for approval: the social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive reimbursement for medical insurance at the designated bank.

to sum up, according to the relevant regulations, people who participate in the basic medical insurance for urban workers or the basic medical insurance for urban and rural residents and suffer from designated chronic diseases can apply for outpatient treatment of chronic diseases. After the insured person is approved, he will enjoy the outpatient treatment of special chronic diseases in the current quarter from the next month. The insured person who has passed the approval can hold his social security card for outpatient treatment in designated medical institutions and purchase medicines in designated pharmacies for chronic diseases. The reimbursement standard for chronic diseases is: the annual deductible standard is 3 yuan, and the outpatient medical expenses that meet the requirements for the treatment of overall diseases are reimbursed by 8% for urban workers and 5% for urban residents above the deductible standard.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.

article 29

the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency, medical institutions and pharmaceutical trading units.

the social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in different places, so as to facilitate the insured to enjoy the basic medical insurance benefits.