According to the requirements of Liaocheng Municipal Health Insurance Bureau, Liaocheng City employees and residents of outpatient chronic special diseases implement the province's unified 48 basic types of outpatient chronic special diseases (see Annex 1). During the transition period, the types of diseases beyond the provincial disease catalog will be retained, and before December 31, 2024, it will be the transition period for adjusting the types of outpatient chronic special diseases. During this period, in addition to the strict implementation of the Catalog of Basic Outpatient Chronic and Special Diseases, the city retains the types of outpatient chronic and special diseases that exceed the provincial regulations (see Attachment 2). Since January 1, 2025, the implementation of the province's unified "outpatient slow special disease basic disease catalog", beyond the provincial provisions of the disease is no longer identified, has been identified personnel are no longer entitled to reimbursement of outpatient slow special disease.

A clear annual starting standard and payment limit

New outpatient chronic special diseases (see Annex 3) set the annual starting standard and payment limit. The annual accumulative starting payment standard of the basic medical insurance for outpatient chronic special diseases for employees and residents is 600 yuan and 500 yuan respectively (referring to the costs included in the overall plan), which is the responsibility of the insured. The new outpatient chronic special diseases are subject to disease-specific limits, and for patients suffering from multiple chronic special diseases at the same time, the limit is the sum of the limits of the diseases of the chronic special diseases they are suffering from. Within a year, the medical expenses incurred by the insured in the designated medical institutions for hospitalization, general outpatient co-ordination and outpatient chronic special diseases (including the policy of separate payment for medicines) are combined to use the maximum payment limit of the co-ordination fund.

Clarifying the reimbursement rate

Outpatient slow special disease patients in the city outpatient slow special disease designated medical institutions incurred disease-related outpatient costs included in the coordinated reimbursement of outpatient slow special disease, of which 85% of the active employee fund, 90% of the retired employees, the residents of the fund to pay for 65%, some of the special disease fund to pay for the proportion of the original policy. After the reimbursement of outpatient chronic and special disease medical expenses by the basic medical insurance, the part of the medical insurance policy covered by the individual's out-of-pocket expenses, the expenses below the starting standard and the expenses above the payment limit are included in the scope of coverage of the major disease insurance (including the employee's large amount of medical subsidies) and the medical aid in accordance with the regulations.
*** Translated with www.DeepL.com/Translator (free version) ***

附件1：

 门诊慢特病基本病种目录 

附件2：

 附件3：

 新增门诊慢特病病种