Generally speaking, the diseases that can be reimbursed by outpatient medical insurance for special diseases that citizens care about are:
Liver cirrhosis, psychosis, malignant tumor, hepatolenticular degeneration, hepatitis C, Parkinson's disease, rheumatoid arthritis, coronary heart disease, three-needle hypertension, diabetes, renal dialysis, kidney transplantation, chronic heart failure, chronic renal insufficiency, systemic lupus erythematosus, breast cancer (endocrine therapy), liver transplantation, hematopoietic stem cell transplantation, prostate cancer (endocrine therapy), epilepsy, bladder tumor.
Then, what is the proportion of medical insurance reimbursement for special diseases?
I. Qifubiaozhun:
The minimum payment standard for urban workers is 800 yuan, and the minimum payment standard for urban and rural residents is 500 yuan;
In a natural year, there is no deductible for category I diseases, two deductible lines for category II and III diseases, but they will not decrease gradually, and there is only one deductible line for category IV diseases.
The medical insurance fund shall bear the medical expenses compensation for each patient with severe macular degeneration for no more than 2 years, and the single eye payment for rehabilitation eye injection shall be less than 5 (inclusive), and the payment period can be continuously calculated. If the insured interrupts the treatment within the compensation period, the payment time will stop.
Tyrosine kinase inhibitors that everyone cares about are also reimbursed, and the compensation that can generally be obtained is as high as 75%. Mutual aid for serious illness, serious illness in urban and rural areas and old supplement are not responsible for this. The maximum compensation of the overall fund for tyrosine kinase inhibitors is 60,000 yuan, and the insured's simultaneous occurrence of two diseases does not exceed this limit.
Second, outpatient special disease reimbursement standards
Reimbursement formula:
(Total outpatient expenses during a treatment period-all expenses-Qifubiaozhun-individual pays first) * Compensation ratio
Reimbursement ratio:
(1) Compensation ratio of basic medical insurance:
Urban workers: 85% can be reimbursed, with an increase of 2% when they reach the age of 50, 4% or 89% when they reach the age of 60, 6% when they reach the age of 70, and 8% when they reach the age of 80 (inclusive). The reimbursement rate is within 100%.
Urban and rural residents: low-grade payment and students and children: the reimbursement ratio is 50%; The reimbursement rate of high-level payers is 65%;
(2) Compensation ratio of supplementary insurance:
Low-grade: {Total disposable medical expenses-all at one's own expense-Qifubiaozhun-overall payment amount of basic medical insurance }*38%- High-grade payment line amount this year: {Total disposable medical expenses-all at one's own expense-minimum payment standard-overall payment amount of basic medical insurance }*77%- What line amount is paid for serious illness this year?
To sum up, there are 2 1 kind of diseases that can be reimbursed by outpatient medical insurance for special diseases, and the reimbursement ratio of different diseases for different insured persons is different, with the maximum not exceeding 100%.