Interpretation of medical insurance outpatient treatment reimbursement for urban and rural residents in Wuhan
First, general outpatient treatment
1, Qifubiaozhun:
(1) Residents in community health service centers (without medical grade), township hospitals, community health service stations and village clinics have no minimum threshold;
(2) Cumulative outpatient Qifubiaozhun in 200 yuan in other medical institutions throughout the year.
2. Reimbursement ratio:
The proportion of residents' medical insurance fund payment is 50%.
3. Reimbursement amount:
Annual payment limit 400 yuan.
Note: The medical expenses for prenatal check-up in outpatient clinics that meet the fertility policy and those for general outpatient clinics are calculated together, and the relevant regulations for general outpatient clinics are implemented.
Two, hypertension, diabetes outpatient medication security benefits
1, object of reimbursement:
The target of this treatment is the residents who need to take antihypertensive drugs and hypoglycemic drugs and are not included in the scope of outpatient treatment for severe (chronic) diseases in Wuhan.
2. Reimbursement ratio:
Within the scope of the policy, the overall fund payment ratio is 50%.
3. Reimbursement amount:
(1) The maximum monthly payment limit for hypertension is 30 yuan;
(2) The highest monthly payment limit for diabetes is 40 yuan;
(3) The monthly payment limit for "two diseases" is 50 yuan.
4, medical management and treatment:
(1) diagnosis confirmation: the insured person needs to go to the designated medical institution in Wuhan for diagnosis confirmation. Insured persons who meet the relevant diagnosis shall go through the registration formalities at the hospital medical insurance office with the Application Form for Outpatient Medication of Hypertension and Diabetes among Urban and Rural Residents in Wuhan. After confirmation, the medical insurance office will enter the relevant information into the medical insurance settlement system and stamp the prescription and application form.
(2) Medication filing: Insured persons diagnosed in designated medical institutions at level 2 or above can hold their ID cards and application forms stamped by designated medical institutions at level 2 or above, and choose qualified designated primary medical institutions to apply for medication registration and filing according to the principle of proximity and convenience.
Three, outpatient treatment of severe (chronic) disease treatment
1, sickness reimbursement:
There are 32 kinds of serious (chronic) diseases treated in outpatient department (phenylketonuria 20 19 is included in the scope of serious (chronic) diseases in outpatient department).
2. Reimbursement ratio:
(1) The basic medical insurance fund pays 50%;
(2) The proportion of compensation for phenylketonuria is 70%.
3. Reimbursement amount:
(1) The annual payment limit of the basic medical insurance fund is 4,000 yuan to 1.5 million yuan.
(2) The insured who has undergone radiotherapy and chemotherapy for malignant tumor (including leukemia), dialysis treatment for chronic renal failure, anti-rejection after kidney transplantation and anti-rejection after liver transplantation can pay a maximum of 300,000 yuan.
Note: The types of diseases, payment proportion and annual payment limit for outpatient treatment of severe (chronic) diseases are all implemented in accordance with the Notice on Adjusting Relevant Policies of Outpatient Treatment of Severe (chronic) Diseases in Basic Medical Insurance (No.46 [2017]).