The payment ratio of urban employee outpatient chronic disease pooling funds is 90%. The maximum payment per patient per quarter shall not exceed 800 yuan, and the maximum payment per person per year shall not exceed 3,200 yuan. For those who suffer from two or more diseases at the same time, the pooling fund payment per person will increase by 200 yuan per quarter, and the annual increase will be 800 yuan, up to a maximum of 4,000 yuan.
The payment ratio of urban and rural residents' pooling fund is 70%. The maximum payment per person per quarter shall not exceed 400 yuan, and the maximum payment per person per year shall not exceed 1,600 yuan. For urban and rural residents suffering from two or more diseases at the same time, the pooling fund payment per person per quarter will be increased by 100 yuan, and the annual increase will be 400 yuan, up to a maximum of 2,000 yuan.
Include the costs of radiotherapy, chemotherapy, immunotherapy, endocrine therapy, anti-pain treatment, and disease-related disposable medical materials, examinations, and service facilities incurred by patients with malignant tumors in the outpatient clinics of designated medical institutions. The scope of medical insurance payment and the proportion of pooling fund payment shall be based on the corresponding hospitalization proportion of urban employees or urban and rural residents.
The treatment expenses incurred by uremic dialysis patients in the outpatient clinics of designated medical institutions will still be implemented according to the original policy. However, according to the needs of their condition, dialysis patients can use L-carnitine, iron, calcium, For drugs that regulate abnormal calcium and phosphorus metabolism, the pooling fund payment ratio is based on the corresponding hospitalization ratio for urban employees or urban and rural residents.
The outpatient reimbursement standards for anti-rejection treatment (liver, kidney, lung, heart transplant) after organ transplantation remain unchanged from the original standards. For disease-related treatment drugs and examination and examination expenses incurred in designated medical institutions due to illness, the limit of no more than 25% of the annual limit for outpatient treatment will no longer be implemented. If the same patient undergoes multiple (secondary) organ transplants, the maximum annual outpatient payment limit will be calculated based on the time of the last (secondary) organ transplantation, and the anti-rejection treatment treatment standards for single organ transplantation will be implemented.
Unified medical insurance designated management shall be implemented for outpatient chronic disease treatment for urban employees and urban and rural residents. Insured patients should apply for chronic disease declaration and certification at designated designated medical institutions. After passing the certification, they can enjoy corresponding benefits. Patients who already enjoy chronic disease benefits should seek medical treatment and purchase medicines at outpatient clinics of designated medical institutions under basic medical insurance or designated retail pharmacies for chronic diseases in accordance with regulations. Medical expenses incurred within the policy scope of designated medical institutions or designated retail pharmacies are included in the scope of payment of the unified fund. The payment of the unified fund is subject to quarterly limit management. There is no deductible standard, no accumulation, no rollover, no carryover, and are uniformly included in the medical insurance. Within the annual maximum payment limit.
Legal basis: "Harbin City Medical Insurance Interim Measures for Medical Expenses Subsidies for Outpatient Treatment of Special Chronic Diseases"
Article 5 Medical Diagnosis Standards for Outpatient Treatment of Special Chronic Diseases shall be determined by the city's special chronic disease outpatient treatment experts The Appraisal Committee is responsible for formulating.
Article 6 Persons who apply for medical subsidy benefits for outpatient treatment of special chronic diseases shall apply to the municipal medical insurance agency with relevant medical materials within the specified time. After being qualified through preliminary review by experts organized by the medical insurance agency and passing the physical examination, it will be submitted to the Municipal Special Chronic Disease Outpatient Treatment Expert Appraisal Committee for approval. For critically ill people with limited mobility, the municipal medical insurance agency will provide door-to-door services.