The minimum payment standard and annual reimbursement amount are different in different regions. Generally, the regional ceiling is about 3, yuan per year. Please ask the local medical insurance center about the specific reimbursement amount.
To apply for medical insurance for chronic hypertension, you should go to a 3A or above hospital and hang up with the Cardiovascular Department for relevant examination. After the hypertension is confirmed, the doctor will issue a medical record certificate of hypertension and prescribe antihypertensive drugs for one month. 2. After getting the medical insurance card, you can choose a 3A or above hospital and a community health service station to handle the designated point, and you can enjoy a monthly antihypertensive drug subsidy of 1-15 yuan +15-3 yuan +65% of hospitalization expenses.
Not all patients with hypertension can enjoy the chronic disease policy of hypertension clinic. Because it is paid by the medical insurance department, it must be attended by social security personnel, units or individuals.
After meeting the first condition of insurance, the condition of hypertension itself must meet certain requirements:
First, it is primary hypertension above grade 2, that is, the blood pressure is above 16/1mg;
In addition, one of the following six items is generally required:
1. Cardiac examination shows left ventricular hypertrophy;
2. The fundus artery is generally or locally narrow, and the fundus hemorrhage and exudation are
3. protein and plasma creatinine concentration are slightly increased in laboratory tests;
4. Cerebral hemorrhage, cerebral infarction or hypertensive encephalopathy;
5. Left heart failure;
6. Renal failure.
The subsidy policy standards for chronic diseases in rural areas are as follows:
1. Minimum payment standard:
(1) The minimum payment standard for chronic diseases in designated community health service institutions is 2 yuan. In designated specialized hospitals, the first-level hospital's deductible standard for chronic diseases is 2 yuan, and the second-level hospital's deductible standard for chronic diseases is 4 yuan. Medical expenses above Qifubiaozhun and below the annual maximum payment limit for chronic diseases in outpatient department shall be reimbursed in proportion, and the outpatient co-ordination fund shall pay 5%;
(2) For those who suffer from two or more chronic outpatient diseases, the annual payment limit shall be determined according to the principle of high or low, and on this basis, the annual payment limit per person shall be increased by 2 yuan;
(3) Outpatients with chronic diseases can't enjoy outpatient medical treatment at the same time during hospitalization. When calculating the maximum payment limit of basic medical insurance, outpatient medical expenses and hospitalization medical expenses will be calculated together;
(4) The outpatient medical treatment for special diseases shall be implemented according to the hospitalization standard, and the deductible line shall be calculated only once in one insured year, and the deductible standard shall be implemented according to the hospital level standard.
2. recipients of chronic diseases. Including the insured including enterprises, institutions and institutions. Individual insured persons with flexible employment can enjoy chronic disease subsidies;
3. Subsidy standard for chronic diseases:
(1) Subsidy standard for chronic diseases in 219. Retired workers (post) retired workers who participated in revolutionary work before the founding of the People's Republic of China and retirees over 7 years old, the threshold for hypertension phase II and hypertension phase III is 1,2 yuan; 1 yuan Qifubiaozhun; 8 yuan.
(2) The subsidy ratio of coronary heart disease (angina pectoris, myocardial infarction):
The community health service institution is 7%;
6% in non-community health service institutions.
Legal basis:
Article 29 of the Social Insurance Law of the People's Republic of China
The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency, medical institutions and pharmaceutical trading units.
the social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in different places, so as to facilitate the insured to enjoy the basic medical insurance benefits.
Article 3
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(1) Those that should be paid from the industrial injury insurance fund;
(2) It shall be borne by a third party;
(3) It shall be borne by public health;
(4) seeking medical treatment abroad.
the medical expenses shall be borne by the third party according to law. if the third party fails to pay or cannot determine the third party, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund has paid in advance, it has the right to recover from the third party.
Notice of the State Medical Insurance Bureau, the Ministry of Finance and State Taxation Administration of The People's Republic of China on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 221 II. Consolidate and improve the medical insurance benefits for urban and rural residents
We should do a good job in landing the list of medical insurance benefits, resolutely establish the awareness of list and scientific decision-making, and strictly implement the scope and standards of basic medical insurance payment. It is necessary to strengthen the convergence of the triple security system of basic medical insurance, serious illness insurance and medical assistance, and give full play to the comprehensive security function. Further consolidate and stabilize the level of hospitalization benefits, stabilize the proportion of fund payment at around 7% within the policy scope, improve the outpatient chronic disease and special disease treatment guarantee and general outpatient co-ordination, and do a good job of treatment convergence. We will continue to do a good job in implementing the drug security policy for outpatients with hypertension and diabetes, carry out special actions, and organize unified demonstration city activities in all provinces (autonomous regions and municipalities directly under the Central Government). Conditional areas can explore the inclusion of chronic diseases such as cardiovascular and cerebrovascular diseases in the scope of chronic disease protection, give play to the role of medical insurance in promoting early diagnosis and treatment of chronic diseases, and improve the level of health management. We will speed up the improvement of the medical insurance and assistance system for major diseases, and the serious illness insurance will continue to implement the preferential payment policy for the extremely poor, the low-income recipients and the people returning to poverty, improve the unified and standardized medical assistance system, reasonably determine the standard of assistance treatment according to the actual situation, and consolidate the guarantee function of medical assistance.
it is necessary to standardize the setting of waiting period for treatment enjoyment (hereinafter referred to as "waiting period"), and there is no waiting period for those who participate in residents' medical insurance during the centralized enrollment period, those who participate in residents' medical insurance within 3 months after the employee's medical insurance payment is interrupted, and special groups such as newborns and rural low-income people.