1. What is a special chronic disease?
Special chronic diseases generally refer to ordinary diseases that need long-term medication, such as hypertension, diabetes, coronary heart disease and so on. There are dozens of special chronic diseases, and each city and each type of medical insurance regulations are slightly different. Let me tell you a simple method. If you have a disease and need to take medicine for a long time, then this disease is probably a special chronic disease. You should consult the retirement department or medical insurance department of your unit.
Second, how to reimburse the outpatient medical expenses for special chronic diseases?
Generally, it is reimbursed once a year according to the hospitalization standard. For example, Lao Wang suffers from stage III hypertension and goes to the hospital to buy antihypertensive drugs once a month, which costs 3,600 yuan for the whole year. The medical insurance of Lao Wang's city stipulates that the minimum payment standard for hospitalization is 600 yuan, and the reimbursement rate for hospitalization is 80%. Then the cost of 3,600 yuan spent by Lao Wang, excluding 600 yuan's threshold fee, multiplied by 80%, is the expense that can be reimbursed, that is, Lao Wang Can reimbursed 2,400 yuan. If Lao Wang doesn't apply for a special chronic disease card, then Lao Wang Can will only bear the 3600 yuan he spent.
In the actual reimbursement process, the hospital will directly reimburse you after deducting the threshold fee. Take Lao Wang for example. Lao Wang spends 300 yuan every month and pays 300 yuan every month for the first two months. Since the third month, he only needs to pay 60 yuan to the hospital every time.
3. What are the procedures for reimbursement of outpatient expenses for special chronic diseases?
1. In the hospital discharge summary, it is recorded that you have a special chronic disease;
2. Generally, it can be handled directly at the medical insurance window of the hospital;
3. If you live in a different place, take the discharge summary to the unit retirement department and fill out the application form, which will be handled by the retirement department in conjunction with the medical insurance department.
4, in the outpatient treatment of special chronic diseases, can only choose a hospital, in other hospitals can not be reimbursed.
Take Lao Wang for example. Lao Wang has been in good health since he retired. Suddenly one day, he felt unwell. After being hospitalized in the hospital, he was diagnosed with diabetes. When he left the hospital, the doctor told him that he had other diseases and needed to take medicine for a long time. There are several diseases written on the discharge summary, which Lao Wang doesn't understand very well. Lao Wang took the discharge summary to the hospital medical insurance window and asked if he could get a special chronic disease card. At the medical insurance window, the staff told Lao Wang that he had three special chronic diseases, diabetes, hypertension and cerebral infarction, all of which could be handled. After handling the chronic disease card, the outpatient medical expenses of three diseases can be reimbursed according to hospitalization. So Lao Wang handled a special chronic disease card at the medical insurance window of the hospital, which was very convenient.
After all the formalities are completed, the medical insurance department will issue you a special chronic disease card with your personal information and the designated hospital you choose. With a special chronic disease card, you can directly reimburse yourself in your designated hospital. For those who live in different places, you need to advance the outpatient medical expenses yourself, and then submit the invoice to the retirement department of the unit, and the staff of the retirement department will go to the medical insurance department to handle the reimbursement procedures for you.