Tongling City issues new medical insurance regulations to provide real-time settlement of outpatient subsidies for chronic diseases

The insurance editor will help you answer your questions. For more questions, you can answer them online.

First, after participating in urban residents’ medical insurance, you can apply for outpatient chronic disease identification.

Second, 1. Scope of outpatient chronic diseases

①. Coronary atherosclerotic heart disease (excluding latent);

②. Primary disease Hypertension (limited to people over 50 years old);

③, diabetes (limited to those with the following chronic complications: microvascular disease, diabetic encephalopathy, kidney disease, diabetic foot damage, and retinopathy stage II or above ).

2. Outpatient chronic disease review and identification standards

3. Application and approval process: Insured residents suffering from the above chronic diseases must apply in person and provide the following information to the community labor and social security workstation : Copies of inpatient medical records, original outpatient medical records, original inspection reports, CT reports, coronary angiography reports, copies of rescue medical records, "Resident Medical Guarantee", ID card and copy, and a recent 2-inch color photo of myself open. The Medical Insurance Coordinator of the community labor and social security workstation will fill in the "Urban Resident Basic Medical Insurance Outpatient Chronic Disease Application Appraisal Form" and report it to the district and county medical insurance agency.

District and county medical insurance agencies will review the reported medical records and related information based on the outpatient chronic disease review and appraisal standards. If the insured residents’ condition meets the outpatient chronic disease standards, they will uniformly fill in the "Urban Resident Basic Medical Insurance" "Outpatient Chronic Disease Identification Form" shall be reported to the municipal medical insurance agency for review. Based on the review results, the municipal medical insurance agency will identify the list of insured residents who enjoy outpatient chronic disease subsidies and feed back the list to the insured residents step by step.

4. Medical treatment procedures: After approval, insured residents who are recognized as enjoying outpatient chronic disease subsidies can seek medical treatment at medical insurance designated medical institutions (including designated community health service institutions). At the same time, the treatment plan prescribed by the physician at the designated medical institution will be recorded in the outpatient medical record. The scope of medication used by urban residents to treat chronic diseases is limited to the "Local Basic Medical Insurance and Work Injury Insurance Drug Catalog". The medication must be consistent with the individual's treatment plan, and large prescriptions or drugs outside the scope of use are not allowed.

5. Cost settlement: Insured residents who are recognized as enjoying outpatient chronic disease subsidies will, at the end of June each year, be recognized as receiving outpatient prescriptions, outpatient fee bills, and laboratory, examination, and treatment fee bills for the year they receive the benefits. Submit relevant materials and other relevant materials to the community labor and security workstation, which will compile and summarize them and report them to the district and county medical insurance agency. District and county medical insurance agencies shall comply with the provisions of Paragraph 4 of Article 18 of the "Interim Measures" (if the cumulative medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed 350 yuan in one year, the excess shall be borne by the overall planning fund at a rate of 50% (standard payment, the maximum payment limit of the unified fund is 2,000 yuan), the medical expenses will be reviewed, and settled after review and confirmation by the municipal medical insurance agency. District and county medical insurance agencies will pay chronic disease subsidy fees.