Deal with major medical insurance situations
1. Medical records of the insured in recent three years (prerequisites), including discharge records and inspection reports during hospitalization, etc.
2, in line with the outpatient chronic (severe) disease identification of diseases.
3. Personal social security card.
Handle important medical insurance processes
1. Take the above information to the local medical security service center for preliminary examination.
2, the preliminary examination qualified outpatient severe (chronic disease) approval registration form, fill in the "outpatient severe (chronic disease) approval registration form" to the designated hospital for identification.
3. After passing the appraisal, bring the qualified appraisal form, my one-inch color registration photo and the original ID card to the medical security service center for relevant registration procedures. Urban and rural residents' medical insurance pays 50% for radiotherapy of malignant tumor (including leukemia) with serious (chronic) diseases, and the annual payment limit is 1.5 million yuan (combined with general outpatient service, hospitalization and outpatient emergency rescue, the maximum reimbursement for serious illness insurance is 300,000 yuan).
What diseases can critical illness insurance do?
Serious diseases (7 kinds):
Grade 3 hypertension (one of the complications of heart, brain, kidney and aorta), diabetes (one of the complications of heart, kidney, eye, nerve and blood vessel), severe psychosis (including schizophrenia, mood disorder and brain organic mental disorder), radiotherapy and chemotherapy for malignant tumor (including leukemia), renal dialysis treatment for chronic renal failure, anti-rejection after renal transplantation and anti-rejection after liver transplantation.
Chronic diseases (24 kinds):
Chronic renal failure (chronic kidney disease stage 4 and above), antiviral therapy for hepatitis B, antiviral therapy for hepatitis C, chronic severe hepatitis and cirrhosis (decompensated stage), chronic obstructive pulmonary disease (GOLD3 grade 3 and above), chronic pulmonary heart disease (reaching decompensated stage of pulmonary heart function), hyperthyroidism (with hyperthyroidism heart disease), severe aplastic anemia, hemophilia and systemic erythema. Rheumatoid arthritis (X-ray examination shows that the joint lesion is in stage III or above), systemic sclerosis (reaching the stage of skin lesion hardening or atrophy), ankylosing spondylitis (accompanied by "radiation sacroiliitis"), Parkinson's disease and Parkinson's syndrome, after vascular interventional therapy, after heart valve replacement, autism (autism spectrum disorder), cerebral palsy, mental retardation (accompanied by mental symptoms) and myasthenia gravis (myasthenia gravis). After surgical treatment of sequelae of cerebrovascular disease (confirmed by imaging and accompanied by severe neurological deficit), epilepsy, coronary heart disease (heart failure reaching refractory end-stage heart failure), rheumatic heart disease (heart failure reaching refractory end-stage heart failure) and coronary heart disease.
procedure
Some patients with major diseases who need long-term outpatient treatment in the hospital can apply for outpatient (chronic) treatment (referred to as medical insurance) and enjoy outpatient reimbursement for related diseases.
At present, the diseases that have been included in the outpatient treatment of serious diseases (chronic diseases) include hypertension, diabetes, renal dialysis, kidney transplantation, malignant tumor, chronic severe hepatitis cirrhosis, Parkinson's disease and Parkinson's syndrome, chronic aplastic anemia, systemic lupus erythematosus, anti-rejection after liver transplantation, chronic renal failure, antiviral treatment of hepatitis B, antiviral treatment of hepatitis C, chronic obstructive pulmonary disease above grade III, chronic pulmonary heart disease, hyperthyroidism, hemophilia, Rheumatoid arthritis, systemic sclerosis, ankylosing spondylitis, polycythemia vera (aplastic anemia), myasthenia gravis (hypertension), psychosis, childhood autism, cerebral palsy and mental retardation after percutaneous coronary intervention.
The process is as follows:
First instance:
Required information:
1. Personal application: the name of the disease must be indicated, and each identification is limited to one disease. When suffering from a variety of diseases, please apply in stages (the unit where the occupational insurance insured person works is stamped, the neighborhood committee where the insured person works is stamped, and the flexible employees do not need to stamp).
2, social security card, ID card (copy)
3, nearly two years of continuous outpatient medical records
4. Copy of hospitalization medical records in the past year: including relevant examination certificates or pathological examination sheets, and records of cancer radiotherapy and chemotherapy (original and copy). Cancer patients), hemodialysis records (renal dialysis patients) and medical records must be stamped with the seal of the hospital.
5. Summary of hospitalization and discharge (original and copy)
6. A bareheaded photo of yourself.
The social security of the jurisdiction will conduct a preliminary examination of the above information, and the patients who pass the preliminary examination will receive two copies of the Registration Form for the Examination and Approval of Outpatient Treatment of Severe (Chronic) Diseases in the Basic Medical Insurance for Urban Employees in Wuhan, with the unit in the upper left corner of the approval form stamped (if there is no unit, the social security of the jurisdiction will cover the official seal of flexible employees).
Logo:
(1) For patients who have obtained the critical examination and approval registration form, please fill in the personal information of the examination and approval form and choose the designated hospital.
(2) to the designated hospital for identification, by the hospital qualified doctors for identification, and pay the appraisal fee, with payment receipts and materials to the hospital medical insurance office for review and seal.
Ratification:
(1) Submit the examination and approval registration form together with the original medical records at the time of preliminary examination to the social insurance agency in the jurisdiction for review. The results usually come out in a week.
(2) After the examination and approval, purchase the Special Medical Records for the Treatment of Severe Diseases in the Outpatient Department of Basic Medical Insurance for Urban Employees in Wuhan (3 yuan Money) at the District Social Security Office, and affix photos and seals.
Archive:
(1) After re-inspection, one approval form is kept in the social security of the jurisdiction, and the other approval form is submitted to the medical insurance office of the treatment hospital for the record.
(2) The medical records of severe cases shall be sealed by the Medical Insurance Office of the treatment hospital (attached with medical insurance card, copy of ID card and photo page of severe cases).
Treatment:
Those who pass the examination and approval, with the medical insurance card and the "Special Medical Records for Outpatients with Serious Diseases in the Basic Medical Insurance for Urban Employees in Wuhan", shall seek medical treatment in designated hospitals at or above the second level according to the principle of convenience and proximity. Class A and B drugs and diagnosis and treatment items used in the outpatient department of serious diseases are limited to the catalogue of serious diseases (chronic diseases) in medical insurance. 100% of out-of-range drugs and treatment items are paid by individuals.
When prescribing medicine for critically ill patients, one dose shall not exceed 15 days.
? Out-of-pocket proportion of serious chronic diseases in outpatient department
Announcement 202 1
The 2002 1 second centralized declaration of special chronic diseases in daye city basic medical insurance outpatient department will be officially launched on September 1 day, and the centralized declaration time will be from September1day to September 30, and the rest of the time can be reported sporadically in various acceptance windows. The specific announcement is as follows:
First, declare the scope of chronic diseases
1, the scope of diseases declared by employees' medical insurance
1 severe hepatitis, cirrhosis, psychosis, hypertension, diabetes, rheumatoid arthritis, coronary heart disease, systemic lupus erythematosus, myasthenia gravis, Parkinson's disease, and Parkinson's syndrome. Five chronic diseases, such as 12 organ transplantation (anti-rejection therapy) 13 chronic renal failure (uremia stage) 14 aplastic anemia 15 cancer 16 hemophilia, can be reported to the Medical Insurance Office of township hospitals and the No.47 window of the Medical Insurance Bureau of the municipal government service center at any time.
2, urban and rural residents to declare the scope of medical insurance diseases
1 cirrhosis 2 antiviral treatment of chronic severe hepatitis 3 systemic sclerosis 4 sequelae of cerebrovascular accident (cerebral hemorrhage, cerebral infarction) 5 hyperthyroidism 6 hypothyroidism 7 bronchial asthma (chronic duration) 8 chronic obstructive pulmonary disease 9 gout 10 multidrug-resistant tuberculosis 1/nephrotic syndrome 12 ankylosing spondylitis/kloc-. 3 Idiopathic Thrombocytopenic Purpura 14 Rheumatic Heart Disease 15 Chronic Pulmonary Heart Disease 8+09 Hypertension 20 Diabetes 2 1 Rheumatoid Arthritis 22 Coronary Heart Disease 23 Systemic Lupus Erythematosus 24 Myasthenia 25 Parkinson's Disease 26 Parkinson's Syndrome 27 Chronic Renal Failure (renal decompensation) 28 Epilepsy and other 28 chronic diseases are centrally declared. 29 Rehabilitation treatment of children with cerebral palsy (0-6 years old) 30 Malignant tumor radiotherapy and chemotherapy clinic 365,438+0 Chronic renal failure (uremia stage) 32 Organ transplantation (anti-rejection treatment) 33 Aplastic anemia 34 children with phenylketonuria 35 hemophilia and other seven chronic diseases can be declared at any time to the Medical Insurance Office of township hospitals and the No.47 window of the Medical Insurance Bureau of the municipal government service center, without any time limit.
Second, the centralized declaration location
1. Employees and residents with no medical records should report to Room 202, the second floor of the administrative building of Daye Ren Peng Hospital (formerly Daye Tongren Hospital).
2 residents with medical records should report to the medical insurance office of the township health center where they are insured. Residents of Dongyue Sub-district Office declare to the Medical Insurance Office of daye city Third Hospital, and residents of the Development Zone declare to the Medical Insurance Office of Luojiaqiao Health Center.
Sporadic reporting locations are medical insurance offices of township hospitals and medical insurance bureaus of municipal government service centers.
Third, the application materials
1, social security card or ID card (copy)
2, nearly three years (20 19, 2020, 202 1) in any year due to related diseases in secondary and above medical institutions (original outpatient medical records, hospital medical records copy stamped with the official seal of the medical institution's medical record room).
3. Relevant inspection reports
Tel: 0714-87173360714-87680990714-8865786.
Daye city Medical Security Bureau
202126 August