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 

序号	病种名称	序号	病种名称
1	恶性肿瘤门诊治疗	25	慢性阻塞性肺疾病
2	骨髓增生异常综合征	26	肺间质纤维化
3	血友病	27	系统性红斑狼疮
4	白血病	28	类风湿性关节炎
5	再生障碍性贫血	29	多发性肌炎（皮肌炎）
6	免疫性血小板减少性紫癜	30	系统性血管炎
7	原发性血小板增多症	31	脊柱关节炎（强直性脊柱炎）
8	真性红细胞增多症	32	系统性硬化症（硬皮病）
9	原发性骨髓纤维化	33	干燥综合征
10	高血压病伴并发症	34	糖尿病
11	冠心病	35	股骨头坏死
12	肺源性心脏病	36	严重精神障碍
13	慢性心力衰竭	37	其他精神障碍
14	尿毒症透析治疗	38	组织或器官移植抗排异治疗
15	慢性肾脏病	39	生长激素缺乏症
16	肾病综合征	40	脑瘫、视力、听力、言语、智力、肢体等残疾儿童和孤独症儿童康复治疗
17	重症肌无力	41	肺结核、肺外其他部位结核
18	脑出血（恢复期、后遗症期）	42	耐多药结核、广泛耐药结核（包括单耐利福平结核）
19	脑梗死（恢复期、后遗症期）	43	慢性乙型病毒性肝炎
20	帕金森病及帕金森氏综合征	44	慢性丙型病毒性肝炎
21	癫痫	45	肝硬化
22	运动神经元病	46	神经系统良性肿瘤门诊治疗
23	肝豆状核变性	47	进行性肌营养不良
24	阿尔茨海默病	48	人类免疫缺陷（HIV）病

附件2：

1	心肌病
2	风湿性心脏病
3	脑卒中（烟雾病）
4	脑卒中（脑血管畸形）
5	冠状动脉搭桥术后状态
6	冠状动脉支架置入术后状态
7	血管支架植入术后状态
8	具有假体心脏瓣膜
9	支气管哮喘
10	中枢神经系统脱髓鞘疾病
11	多脉管炎
12	自身免疫性溶血性贫血
13	结肠代食道手术后遗症
14	苯丙酮尿症

 附件3：

 新增门诊慢特病病种