Question 2: What are the processes of chronic disease medical insurance? 1. Handling conditions: The insured participating in supplementary medical insurance includes: 1, suffering from 12 chronic diseases: diabetes, hypertension (stage II and III), chronic hepatitis (except hepatitis A), malignant tumor, coronary heart disease, Parkinson's disease, sequelae of stroke (including cerebral infarction, cerebral hemorrhage and subarachnoid space).
2, the overall fund to pay the maximum amount of more than 40 thousand yuan of medical expenses.
2. Go through the formalities: 1. Acceptance: 2. Audit of expenses: (1) In 800 yuan, the proportion of supplementary medical insurance fund payment is 70%, and the maximum payment limit is 2,500 yuan; Over the age of 70, the conceit exceeds that of 600 yuan, and the proportion of supplementary medical insurance fund payment is 80%, with a maximum payment limit of 3,000 yuan. (2) The maximum payment limit of the overall fund is more than 40,000 yuan, and the supplementary medical insurance fund pays 90%, with the maximum payment limit of 6,543.8+0.6 million yuan. 3. Go to the local social security department to handle the required information and consult the local social security department specifically.
Application materials: original and photocopy of resident ID card, social security card, recent one-inch bareheaded color photos, photocopy of hospitalization medical records related to declared diseases (stamped with special seal for copying hospitalization medical records) and related image materials (such as X-ray photos, CT photos, inspection reports, etc.). ) .4. Waiting for reimbursement payment.
Question 3: What materials do urban workers need to handle chronic diseases? 1. There are 19 kinds of diseases reported on a regular basis. Accept application materials at the end of each quarter and organize physical examination at the end of each quarter. After the physical examination is completed, they can receive the Certificate of Physical Examination for Outpatients with Special Chronic Diseases within 20-30 working days, and the application materials will not be returned.
1.Type Ⅰ and Ⅱ diabetes: original outpatient medical records or photocopies of inpatient medical records stamped by designated medical insurance hospitals in the last two years, and original relevant laboratory sheets (such as blood sugar, urine sugar, glucose tolerance test, etc.).
2. Chronic viral hepatitis: original outpatient medical records in recent 2 years or copies of inpatient medical records stamped by medical insurance designated hospitals, relevant inspection reports and laboratory tests, such as liver function.
3. Autoimmune hepatitis: photocopies of inpatient medical records stamped by medical insurance designated hospitals, and corresponding examination and laboratory reports (liver function, renal function, protein electrophoresis, serum antibodies, immunoglobulin, antinuclear antibodies, abdominal B-ultrasound, etc.). ).
4. Chronic bronchitis: original outpatient medical records over the years, photocopies of inpatient medical records stamped by designated hospitals with medical insurance, and corresponding inspection and laboratory reports (chest X-ray, allergen test, lung function test, etc. ).
5. Chronic pulmonary heart disease: copies of inpatient medical records stamped by designated hospitals with medical insurance, and corresponding inspection and laboratory reports (electrocardiogram, echocardiography, cardiac Doppler, chest X-ray report, etc.). ).
6. Bronchial asthma: original outpatient medical records over the years, copies of inpatient medical records stamped by designated hospitals with medical insurance, and corresponding inspection and laboratory reports (chest radiographs, lung function tests, etc. ).
7. Stage III hypertension (complicated with heart, kidney, brain and eye complications): copies of inpatient medical records stamped by designated hospitals with medical insurance, and corresponding inspection and laboratory reports (electrocardiogram, brain CT, fundus fluorescein angiography, echocardiography, cardiac Doppler, etc.). ).
8. Coronary heart disease (cardiac function grade III): copies of inpatient medical records stamped by designated hospitals with medical insurance, and corresponding inspection and laboratory reports (such as electrocardiogram and color Doppler echocardiography). ).
9. Psoriasis: The inpatient medical records stamped by the designated medical insurance hospital or the outpatient medical records of more than two years have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
10. Vitiligo: The inpatient medical records stamped by the designated medical insurance hospital or the outpatient medical records of more than two years have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
1 1. Depression (moderate or severe): the inpatient medical records stamped by the designated medical insurance hospital or the medical records of psychiatric outpatient service for more than two years are clearly diagnosed, and the diagnosis certificate issued by the doctor above the deputy director.
12. Nephrotic syndrome: The inpatient medical records stamped by the designated medical insurance hospital have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
13. Chronic glaucoma: A definite diagnosis is made with the medical records of inpatients or outpatients stamped by designated hospitals with medical insurance for more than two years, supported by the positive results of relevant examinations and laboratory sheets.
14. Rheumatic heart disease (complicated with mitral stenosis, mitral insufficiency, aortic stenosis or aortic insufficiency): The inpatient medical records stamped by the medical insurance designated hospital have a definite diagnosis, which is supported by the positive results of relevant tests and laboratory sheets.
15. Tuberculous meningitis: The inpatient medical records stamped by the designated medical insurance hospital have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
16. Lymphadenitis: The inpatient medical records stamped by the designated medical insurance hospital have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
17. Tuberculous peritonitis: The inpatient medical records stamped by the designated medical insurance hospital have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
18. Urinary tuberculosis: The inpatient medical records stamped by the designated medical insurance hospital have a definite diagnosis, which is supported by the positive results of relevant examinations and laboratory sheets.
19. Chronic hepatitis C (with a term of one year): The inpatient medical records stamped by the designated medical insurance hospital in the past year have a definite diagnosis and are supported by the positive results of relevant examinations and tests.
Second, there are 46 diseases that can be declared at any time. In principle, the insured unit shall make a unified declaration as required, and the social security agency shall handle it according to the application materials. Those who meet the requirements can receive the Medical Certificate for Outpatient Service of Special Chronic Diseases within 10- 15 working days, and the application materials will not be returned.
1. Recovery period of cerebral hemorrhage and cerebral infarction: photocopies of inpatient medical records stamped by designated medical insurance hospitals in recent 1 year, and originals of relevant inspection reports. (such as CT, MRI report or film).
2. Dialysis treatment of uremia: copies of inpatient medical records stamped by designated hospitals with medical insurance, relevant inspection reports and laboratory tests, such as renal function measurement.
3. Renal metastasis >>
Question 4: What is medical insurance for chronic diseases? How to deal with the operation? Audit and reimbursement of supplementary medical insurance expenses
1. Handling conditions: The insured participating in supplementary medical insurance includes: 1, suffering from 12 chronic diseases: diabetes, hypertension (stage II and III), chronic hepatitis (except hepatitis A), malignant tumor, coronary heart disease, Parkinson's disease, sequelae of stroke (including cerebral infarction, cerebral hemorrhage and subarachnoid space). 2, the overall fund to pay the maximum amount of more than 40 thousand yuan of medical expenses. 2. Go through the formalities: 1. Acceptance: 2. Audit of expenses: (1) In 800 yuan, the proportion of supplementary medical insurance fund payment is 70%, and the maximum payment limit is 2,500 yuan; Over the age of 70, the conceit exceeds that of 600 yuan, and the proportion of supplementary medical insurance fund payment is 80%, with a maximum payment limit of 3,000 yuan. (2) The maximum payment limit of the overall fund is more than 40,000 yuan, and the supplementary medical insurance fund pays 90%, with the maximum payment limit of 6,543.8+0.6 million yuan. 3. financial payment 3. Application materials: 1. Supplementary information to be provided for medical outpatient service 12 chronic diseases: social insurance card (ic card), medical insurance medical record card of the insured, computer settlement bill and expense list of outpatient medical expenses after personal account is used up, disease certificate issued by the attending physician or above in the municipal hospital and stamped by the medical department, and ID card required for those over 70 years old. 2. Information to be provided for medical expenses with a maximum limit of 40,000 yuan or more: social insurance card of the insured, medical insurance medical record card, computer statement or valid bill for hospitalization or reimbursement, detailed list of medical expenses, bill of payment, discharge summary, supplementary medical insurance payment approval form (exceeding 40,000 yuan for the first time) or letter of introduction from the company (after the second time). Those who enjoy Medicaid for civil servants, regardless of special diseases, will directly return to their personal accounts according to the regulations after the outpatient pays. Other personnel, 12 insured persons with chronic diseases, still need to use ic card to register for medical treatment and settlement after using their personal accounts, and keep the expense list and settlement bills. When the insured applies for reimbursement of supplementary medical insurance after paying the outpatient medical expenses, they need to carry the disease certificate, outpatient medical record, IC card, expense list and all computer bills for paying the outpatient medical expenses in cash issued by the designated hospital, and go to the lobby on the first floor of the municipal social insurance fund management center for review, registration and reimbursement.
In the out-of-pocket expenses of individual medical accounts and the minimum payment standard of supplementary medical insurance (the so-called "threshold fee" of supplementary medical insurance), after the expenses of reported diseases are exhausted, the excess supplementary medical insurance will be partially subsidized. The "threshold fee" for ordinary insured persons is 800 yuan, and 70% of the excess is paid by supplementary medical insurance fund, and the maximum overseas payment limit is 2,500 yuan; The self-paid "threshold fee" for retirees over 70 years old is 600 yuan, and the proportion of over-supplementary medical insurance funds is 80%, and the maximum payment limit is 3,000 yuan; Enjoy the treatment of model workers at or above the provincial level, and enjoy the special allowance of the State Council according to the treatment of retirees over 70 years old. (There is no subsidy for 800 yuan or retirees over 70 years old who are paid within 600 yuan, but only after they exceed it).
How to pay and use supplementary medical insurance premiums for employees?
Answer: All employers and employees must participate in supplementary medical insurance for employees on the basis of participating in basic medical insurance for employees. Supplementary medical insurance premiums shall be paid by the employer according to 65438+ 0.2% of the total wages of employees last month. ?
The employee supplementary medical insurance fund is mainly used for: First, the maximum payment limit of the fund is more than 40,000 yuan, 90% of the supplementary medical insurance payment, 10% of the individual payment, and the maximum payment limit is10.6 million yuan. 2. Diabetes, hypertension (stage II and III), chronic hepatitis (except hepatitis A), malignant tumor, coronary heart disease, Parkinson's disease, sequelae of cerebral apoplexy (including cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage), chronic bronchitis (including bronchial asthma), chronic nephritis (including chronic renal insufficiency), rheumatoid arthritis, systemic lupus erythematosus and chronic aplastic anemia. 65438. After the personal medical account is used up, the self-payment threshold of supplementary medical insurance (the so-called "threshold fee" of supplementary medical insurance) is paid in full, and some subsidies will be given to the excess supplementary medical insurance. The "threshold fee" for ordinary insured personnel is 800 yuan, and the proportion of the supplementary medical insurance fund to pay more than 70%, and the maximum payment limit is 2,500 yuan; Retirees over 70 years old pay "threshold fee" by themselves in 600 yuan ... >>
Question 5: What diseases can chronic diseases apply for as a reference, which varies slightly from place to place:
What diseases can I apply for outpatient treatment of chronic diseases?
1. What diseases can insured employees apply for outpatient treatment of chronic diseases?
1, radiotherapy and chemotherapy for patients with malignant tumor
2, uremia dialysis treatment
3. Anti-rejection therapy for organ transplant patients
4. Hypertension is Grade 3 (one of the complications of heart, brain and kidney)
5, chronic pulmonary heart disease (cor pulmonale)
6, bronchial asthma
7, diabetes (and infection or heart, kidney, liver, nerve complications)
8. Rheumatoid arthritis (active stage)
9. Systemic lupus erythematosus (one of the complications of heart, lung, kidney, liver and nerve)
10, chronic aplastic anemia
1 1, leukemia (those who need to continue chemotherapy)
12, myelodysplastic syndrome;
13, primary thrombocytopenic purpura;
14, chronic nephritis, henoch-schonlein purpura nephritis;
15, Parkinson's syndrome;
16, femoral head necrosis;
17, severe hepatitis, liver cirrhosis;
18, cerebrovascular diseases (cerebral hemorrhage, cerebral infarction, cerebrovascular malformation);
19, ankylosing spondylitis;
20, coronary heart disease;
2 1, scleroderma
22. Demyelination
23 years old, polycythemia vera.
24. Diffuse pulmonary interstitial fibrosis
25, myasthenia gravis
26. Hepatic sinus degeneration
27, motor neurons
28, thromboangiitis obliterans
29, rheumatic heart disease
30 years old, manic psychosis.
3 1, AIDS
32. Dilated heart disease
33. Primary thrombocytosis
34, chronic obstructive pulmonary disease (CODP)
35, Sjogren's syndrome
36 years old, hemophilia.
37, autoimmune hemolytic anemia
38. Segmental ileitis
39, colon sequela due to esophageal surgery
2. What diseases can insured residents apply for outpatient treatment of chronic diseases?
1, radiotherapy and chemotherapy for patients with malignant tumor
2, uremia dialysis treatment
3. Anti-rejection therapy for organ transplant patients
4. leukemia
5, hemophilia
6. Mild mental illness
7. Cerebral vascular diseases
8.parkinsonism
9, coronary heart disease
10, dilated cardiomyopathy
1 1, rheumatic heart disease
12, hypertension grade 3.
13 diabetes
14, liver cirrhosis
15, chronic pulmonary heart disease
16, cerebral palsy
Question 6: What do the elderly need to deal with chronic diseases? You must first go to the medical insurance office to ask for a form, fill it out according to the above requirements, post a photo after filling it out and stamp it in the community. Stamp it and send it to the medical insurance office, and then wait for him to inform you to have a physical examination.
Question 7: What about the medical certificate of chronic diseases of the new rural cooperative medical system? What are the procedures for reimbursement of the new rural cooperative medical system?
Information required for reimbursement:
1. Outpatient reimbursement information: outpatient invoice, cooperative medical certificate calendar (or medical record).
2. Hospitalization reimbursement materials: hospitalization invoice, cooperative medical certificate (or medical record) calendar, detailed list of expenses, discharge summary and other relevant certificates.
3. Special disease outpatient reimbursement: invoices and calendars for special disease cooperative medical certificate outpatient service.
4. Information for handling special diseases: outpatient treatment proposal for special diseases, calendar of cooperative medical certificate, medical records, relevant laboratory reports and photos.
Reimbursement process:
1. The insured households prepare the required materials for reimbursement and submit them to the village (community) cooperative medical liaison, which will report them to the town cooperative medical liaison after review, and the town cooperative medical liaison will send them to the district agricultural medical office for reimbursement. Guide to reimbursement of new rural cooperative medical care.
2. Direct reimbursement by the hospital: When going through hospitalization procedures due to illness, you will issue a certificate of the new rural cooperative medical system to the hospital and directly participate in reimbursement.
Question 8: What about chronic diseases? The declaration of this special chronic disease 1. Scope of application and information: all farmers who participate in the new rural cooperative medical system in our county and whose diseases meet the scope and standards of special diseases determined by our county can apply. Participating farmers who declare special diseases should provide medical records, diagnosis certificates, inspection reports, pathological section reports, CT films and other medical materials related to the disease in public hospitals at or above the county level. 2. Application and evaluation procedures (1) Preliminary examination (conducted by designated medical institutions within the jurisdiction) Participating farmers apply to the township joint management office, which collates and conducts preliminary examination of the application materials, and summarizes the materials of applicants who meet the standards, and submits them to the county-level new rural cooperative medical management center together with their cooperative medical certificate. (II) Review (county new rural cooperative medical management center) The county new rural cooperative medical management center conducts preliminary examination and verification of the medical records reported by the township joint management office. If it meets the review conditions, the county new rural cooperative medical management center will organize expert review. Do not meet the conditions, be returned. (III) Appraisal (expert appraisal group of special diseases of the new rural cooperative medical system in the county) An appraisal group was established in the new rural cooperative medical system management center, and its members were composed of center personnel and medical experts, who were specifically responsible for the appraisal work. Centralized identification is conducted once every six months, and identification is carried out in Lincheng County Hospital and Lincheng County Hospital of Traditional Chinese Medicine through consulting materials, face-to-face diagnosis and review. (4) Establishment of archives: if it meets the requirements after identification, the county new rural cooperative medical management center shall establish archives for standardized management.