What are the provisions of the single-disease overall fund year?
The annual expenditure of the single disease co-ordination fund shall not exceed the annual limit of the disease, and the maximum reimbursement limit for the co-ordination fund suffering from two or more chronic diseases is 5000 yuan per person per year. The outpatient chronic disease treatment of the provincial employees' basic medical insurance insured personnel is paid by the basic medical insurance co-ordination fund, and the outpatient chronic disease expenses are managed separately according to the annual maximum limit, excluding the hospitalization medical expenses, and the annual maximum payment limit of the basic medical insurance fund is calculated. And improve the outpatient chronic disease policy of 4% provincial supplementary medical insurance participants, and adjust the outpatient chronic diseases of 4% provincial supplementary medical insurance participants to 38. The deductible line of outpatient chronic medical expenses is below 200 yuan, and the deductible line is not calculated repeatedly in various chronic diseases. If the deductible line exceeds the policy scope, the personal burden is 40%, and the overall fund burden is 60%. Outpatient chronic diseases shall be subject to the annual quota management of single diseases, and the annual overall fund expenditure of single diseases shall not exceed the annual quota of the disease. The provincial supplementary medical insurance participants continue to maintain the original treatment according to the nine chronic diseases identified in the original policy. After the implementation of the new policy, the declaration and identification of the original nine chronic diseases will no longer be accepted. Nine chronic diseases have been identified according to the original policy, and similar chronic diseases have been declared within the scope of the new policy, and the original treatment will be automatically cancelled. Outpatient chronic disease treatment with 4% supplementary medical insurance for the insured at the same level is paid by 4% supplementary insurance fund, and the outpatient chronic disease expenses are not combined with the hospitalization medical expenses to calculate the annual maximum payment limit of the basic medical insurance fund.
To sum up, the medical expenses above the qifubiaozhun for outpatient chronic diseases and below the annual maximum payment limit will be reimbursed in proportion, and the outpatient co-ordination fund will pay 50%.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.