In order to further optimize the reimbursement process of medical expenses for urban and rural residents and urban workers in our city, improve the convenience service level of medical insurance, and continuously enhance the sense of acquisition and satisfaction of the insured people in the field of medical security. Recently, the Municipal Medical Security Bureau further adjusted and clarified some existing medical security policies in our city.

First, the policy of outpatient renal dialysis (hemodialysis and peritoneal dialysis) for urban and rural residents was adjusted. Outpatient renal dialysis (hemodialysis and peritoneal dialysis) for urban and rural residents is reimbursed in the medical category of chronic and special diseases (medical category code: 14), and the monthly fixed payment is no longer implemented. The one-year deductible for outpatient renal dialysis (hemodialysis and peritoneal dialysis) for urban and rural residents is 150 yuan. At the same time, the reimbursement rate of outpatient renal dialysis (hemodialysis and peritoneal dialysis) for urban and rural residents was adjusted to: 100% (regardless of the inside and outside of the catalogue), and the annual cap line was 73,650 yuan. The policy will be implemented from 1 in 2023.

Two, to further clarify the urban and rural residents' chronic disease deductible policy. In view of the stipulation in the Notice on Adjusting Outpatient Chronic Diseases Policy issued by the Municipal Medical Insurance Bureau on September 5, 2022 that the cumulative deductible for chronic diseases of Class A residents is 2,500 yuan a year, the new measures are as follows: the annual deductible standard for chronic diseases of Class A for urban and rural residents is that the compliance expenses in the area can be reimbursed after reaching 600 yuan, and the compliance expenses outside the area can be reimbursed after reaching 2,500 yuan. The specific accumulation methods are as follows: First, if residents seek medical treatment outside the district for the first time, the combined fee is between 600 yuan and 2,500 yuan, and the combined fee is included in the deductible; If they see a doctor outside the district for the second time, the out-of-pocket payment will not be deducted, and if they see a doctor outside the district, the remaining combined fees will be reimbursed. Second, it is the first time to see a doctor outside the district, and the combined fee is higher than 2500 yuan. Reimbursement will be made after deducting deductible directly, and deductible will not be deducted for subsequent medical treatment in or outside the area. 3. Reimbursement after deducting the 600 yuan deductible for the first time in the region. For the second time outside the district, the deductible line will be replenished from the combined fee to 2500 yuan, and the rest will be reimbursed. The policy will be implemented from 1 1.3 in 2022.

Three, during the epidemic in COVID-19, outpatient patients with chronic diseases and outpatient special drug purchase reimbursement methods to further clarify. In order to cooperate with measures such as silent control of the epidemic, during the silent control period, patients with chronic diseases and patients with special drugs in outpatient clinics who have been registered can purchase the corresponding delayed and special drugs in full from Baogong Pharmacy through the US Mission and other means. After the epidemic situation is unsealed, it can be reported to the local medical insurance agency by the official invoice of the pharmacy, the list of drugs purchased and the announcement issued by the local epidemic prevention and control headquarters (defining the start and end date of the silent measures), and the corresponding drug expenses can be reimbursed according to the relevant delayed or special policies. This measure can be traced back to 1, 2022.

Fourth, further clarify the reimbursement policy for day surgery for urban workers and urban and rural residents. In order to further promote the reform of payment mode of medical insurance, strengthen and standardize the service behavior of medical institutions, improve the efficiency of the use of medical insurance funds, and ensure the basic medical needs of insured persons, according to the spirit of the Notice on Printing and Distributing the Implementation Plan of Payment by Disease for Basic Medical Insurance in Wulanchabu City (17), the policy of daytime surgery is still implemented. The policy is planned to be officially launched on June 65438+ 10/day, 2023.