Urban and rural residents' medical insurance hypertension, diabetes outpatient medication implements "prescribing prescriptions as determined, prescribing medicine is paid" 丨 Reimbursement process →

In order to optimize the medical insurance and diabetes (referred to as two diseases) outpatient treatment process for urban and rural residents, the city implements the management model of "prescribing prescriptions and prescribing medicines". You can enjoy the treatment of "two diseases" outpatient clinics.

——The "two diseases" outpatient drug guarantee population scope

Participate in the basic medical insurance for urban and rural residents, and the medical institution is diagnosed with hypertension, diabetes and prescriptions. It is necessary to take drug treatment and not be included in the “two diseases” patients with the scope of chronic disease guarantee.

—— "Two Diseases" Outpatient Medicine Certification and Reimbursement Process

Step 1: "Determine on the side"

Insured personnel participating in urban and rural residents are visited at the secondary and below designated medical institutions. After prescribing the prescriptions, the prescriptions of the "two diseases" can be included in the "two diseases" outpatient drug guarantee scope of the "two diseases" prescriptions according to the diagnosis and treatment.

Step 2: "Posted by prescribing medicine"

Insured personnel participating in urban and rural residents, the cost of lowering blood pressure and blood glucose drugs occurred by the outpatient clinics at the second and below medical institutions, and reimbursed according to the prescribed proportion.

- "Two Diseases" outpatient medication treatment standards

"Two diseases" patients with blood pressure and blood sugar -lowering drug costs occurred by the fixed -point medical institutions in the secondary and below. 60%of the medical institutions, the maximum payment limit of the annual overall funding fund for hypertension patients is 300 yuan, and the maximum payment limit for the annual overall funds of blood glucose medicine for diabetic patients is 500 yuan.

Kind tips

1. Insurance residents can only enjoy one "two diseases" outpatient treatment in diabetes or hypertension, and cannot enjoy two diseases at the same time.

2. "Two Diseases" outpatient clinics only enjoy the treatment of drug purchases, and other projects will not be reimbursed.

3. The medical expenses of the "two diseases" during the hospitalization of the residents are implemented in accordance with the inpatient reimbursement policy. During the hospitalization period, the "two diseases" outpatient medical expenses cannot occur at the same time.

4. Participants who have enjoyed the treatment of chronic diseases for outpatient clinics continue to implement the existing outpatient chronic disease guarantee policy, and no longer enjoy the "two diseases" outpatient drug treatment.

Example: Insurance residents have chronic disease treatment of diabetes outpatient clinics and cannot be declared for outpatient treatment of both diabetes. There are chronic disease treatment of hypertension outpatient clinics, and the treatment of two -disease outpatient treatment of hypertension can not be declared.

Source: Bingcheng+Client

Reporter Yu Yonglan

PSAs

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