All county (city) medical insurance bureaus, Shuangyang and Jiutai Medical Insurance Branches, and medical insurance agencies at all levels: According to the "Provincial Medical Insurance Bureau and Provincial Department of Finance's Provincial Department of Finance's Notice on Clearly Implementing and Establishing and Improving the Outpatient Financial Security Mechanism for Basic Medical Insurance for Employees"

"Notice on the Requirements" (Jiji Medical Insurance Alliance [Xiansi 2022] No. 22), "Forwarding the Notice of the National Medical Insurance Bureau, the Ministry of Finance and the State Administration of Taxation on the Basic Medical Security for Urban and Rural Residents in 2022" (Ji Xiongliangjiao Medical Insurance Alliance [2022]

No. 25) and the "Notice on Improving the Management of Chronic Diseases and Special Diseases in Jilin Province Basic Medical Insurance Outpatient Clinics" (Jiyibaofa [2022] No. 28), our city's urban employee basic medical insurance (hereinafter referred to as

"Employee Medical Insurance") and the Basic Medical Insurance for Urban and Rural Residents (hereinafter referred to as "Resident Medical Insurance") are notified of relevant matters related to the management of outpatient guaranteed diseases as follows: 1. Clarify the scope of disease categories (1) Outpatient Chronic Diseases Employee Medical Insurance covers 47 types of outpatient chronic diseases (

See 1), among which, there are 27 disease types unified across the province (hereinafter referred to as “provincial chronic disease types”) and 20 self-selected disease types under the city’s employee medical insurance (hereinafter referred to as “self-selected chronic disease types”).

Residents’ medical insurance implements the province’s unified 19 types of outpatient chronic diseases for residents’ medical insurance (see 2).

(2) Special outpatient diseases: Employee medical insurance covers 55 special outpatient diseases, and residents’ medical insurance covers 51 special outpatient diseases (see 3).

2. Strengthen handling and management (1) Management of disease names and codes: Outpatient chronic diseases and outpatient special diseases shall adopt unified disease names and codes across the province. For the same disease in employee medical insurance and resident medical insurance, the disease names and codes shall be consistent.

(2) Disease type admission standards. Please click to enter the picture description (maximum 18 words). Outpatient chronic diseases and outpatient special diseases are subject to the province's unified medical insurance admission standards.

(3) Benefit period: In principle, outpatient chronic disease benefits are valid for a long time and do not require review.

The Municipal Social Medical Insurance Administration should combine the routine diagnosis and treatment and the actual handling work, and set the outpatient special disease benefit period according to the type of disease. The insured person does not re-apply after the benefit enjoyment period expires or does not have outpatient special disease during the benefit enjoyment period.

If there is any fee, the outpatient special disease benefits will be automatically cancelled.

(4) The annual maximum payment limit of the outpatient chronic disease pooling fund of employee medical insurance for multi-disease management is 6,500 yuan. At the same time, the annual maximum payment limit of a single disease pooling fund is set. Those who enjoy multiple outpatient chronic disease protection benefits are within 6,500 yuan.

The annual maximum payment limit of various pooled funds is calculated cumulatively.

The annual medical fee limit and multi-disease management within the scope of the resident medical insurance outpatient chronic disease policy will still be implemented in accordance with the original policy.

3. Make good connections with benefits. This notice will come into effect on January 1, 2023.

Those who have passed the outpatient chronic disease and special disease qualifications and enjoyed benefits before the implementation of this notice will no longer need to apply for qualification certification separately; newly applied insured persons after the implementation of this notice will be processed according to the disease scope stipulated in this notice.

Medical insurance agencies at all levels must organize and coordinate designated medical institutions to ensure the transition of disease names and codes. In particular, diseases with changes in insurance methods must be actively and properly handled and the benefits connected.

: 1. Scope of chronic diseases in employee medical insurance outpatient clinics 2. Scope of chronic diseases in outpatient medical insurance outpatient clinics 3. Scope of special diseases in outpatient clinics Changchun Municipal Medical Security Bureau’s "About Improving the Management of Basic Medical Insurance Outpatient Coverage Diseases" on November 11, 2022

The policy interpretation of "Notice on Matters" is in accordance with the "Notice of the Provincial Medical Security Bureau and the Provincial Department of Finance on clearly implementing the relevant requirements for establishing and improving the outpatient financial security mechanism of basic medical insurance for employees" (Jiji Medical Insurance Alliance [2022] No. 22, hereinafter referred to as 22

Document No. 25), "Forwarding the Notice of the National Medical Insurance Administration, the Ministry of Finance and the State Administration of Taxation on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2022" (Jilin Medical Insurance Alliance [2022] No. 25, hereinafter referred to as Document No. 25) and "On Improving Jilin Province's Basic Medical Security

Notice on Matters Related to the Management of Chronic Diseases and Special Diseases in Basic Medical Insurance Outpatient Clinics (Jiyibaofa [2022] No. 28, hereinafter referred to as Document No. 28), our bureau issued the "About Improving the Management of Basic Medical Insurance Outpatient Covered Diseases"

Notice of Matters" (Chang Medical Insurance Fa [2022] No. 54, hereinafter referred to as the "Notice").

The interpretation is as follows: 1. What is the background of the issuance of the "Notice"? Document No. 22 proposes that "the province will uniformly set disease categories for outpatient chronic and special diseases (specific disease categories will be formulated separately), and gradually transition from disease category protection to cost protection."

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