"Online Office" and "Handheld Office"
Mengzi has realized the online declaration and filing of special and chronic diseases in outpatient clinics of basic medical insurance, that is, applicants can apply for the recognition and filing of outpatient special diseases and chronic diseases through the online application, and can enjoy the treatment of special and chronic diseases in outpatient outpatient clinics of basic medical insurance after filing.
1. Scope of outpatient special diseases and chronic diseases
Patients insured by Mengzi medical insurance who suffer from the following diseases shall apply for the filing of outpatient special diseases and chronic diseases in accordance with the regulations:
(1) Outpatient special diseases, 30 types of outpatient special diseases: malignant tumors, chronic renal failure, anti-rejection therapy after organ transplantation, systemic lupus erythematosus, aplastic anemia (including hereditary spherocytosis, autoimmune hemolytic anemia), Eastern Mediterranean, hemophilia, Parkinson's disease, myasthenia gravis (including muscular dystrophy), motor neuron disease, major psychosis (schizophrenia, schizoaffective disorder, paranoid mental disorder, bipolar disorder, Psychiatric disorders due to epilepsy, mental retardation with psychiatric disorders), childhood growth and development disorders (growth hormone deficiency), pediatric cerebral palsy, childhood immunodeficiency disorders, drug-resistant tuberculosis, rehabilitation of patients discharged from the hospital, HIV antiretroviral therapy, Crohn's disease, amyotrophic lateral sclerosis (ALS), idiopathic pulmonary fibrosis (IPF), multiple sclerosis, idiopathic inflammatory myopathies, dermatomyositis, antisynthetase syndrome, polymyositis/dermatomyositis in children (juvenile), immune-mediated necrotizing myopathy, Mitochondrial myopathy, inclusion body myositis, polymyositis), ankylosing spondylitis, systemic sclerosis (including systemic sclerosis-related interstitial lung disease SSc-ILD), spinal muscular atrophy, Prada-Willi syndrome, Turner syndrome, central precocious puberty in children, Wilson's disease, neuromyelitis optica.
The outpatient special disease medical expenses incurred by the basic medical insurance participants for urban and rural residents in accordance with the regulations shall be calculated as a minimum payment of 1,200 yuan in a natural year, and the reimbursement ratio of medical expenses within the policy shall be 70%.
There is no minimum payment line for chronic renal failure and severe mental illness, and the reimbursement ratio is 90%.
Within a natural year of basic medical insurance for urban employees, the minimum payment standard for outpatient special diseases is 800 yuan, and the minimum payment line for outpatient special diseases and the minimum payment line for hospitalization are calculated separately; Chronic renal failure (uremia) and severe mental illness are paid by the fund, and the proportion of the rest of the diseases is paid according to the hospitalization reimbursement policy. The annual maximum payment limit of the pooled fund and the annual maximum payment limit of hospitalization expenses are combined.
Outpatient chronic diseases, 23 types of outpatient chronic diseases: coronary heart disease, chronic heart failure, chronic rheumatic heart disease, cor pulmonale, chronic obstructive pulmonary emphysema, active tuberculosis, bronchiectasis, bronchial asthma, cerebrovascular accident (cerebral hemorrhage, cerebral thrombosis, cerebral infarction, cerebral atrophy and sequelae), primary or secondary hypertension grade II.-III., liver cirrhosis, chronic active hepatitis, senile prostatic hyperplasia II.o-III.o, chronic glomerulonephritis, nephrotic syndrome, diabetes, Rheumatoid arthritis (including juvenile idiopathic arthritis, juvenile dermatomyositis), hyperthyroidism (hypothyroidism), Alzheimer's disease, epilepsy, Sjögren's syndrome, primary glaucoma, psychosis.
The outpatient chronic disease medical expenses incurred by the participants of the basic medical insurance for urban and rural residents in designated medical institutions shall be paid according to the limit of the disease, and the payment ratio shall be 60%, and the annual payment limit of the overall fund shall be determined according to the standard of the disease.
In a natural year, the minimum payment standard for outpatient chronic diseases of employee medical insurance is 400 yuan, and the minimum payment standard is not deducted quarterly, and the annual expenses that exceed the minimum payment standard of more than 400 yuan are reimbursed in proportion to the overall fund, which is calculated separately from the minimum payment standard for hospitalization; 90% of the pooled fund is paid. The annual reimbursement limit of the pooled fund for a single disease is 2,000 yuan, and the payment limit of the pooled fund can be increased by 500 yuan for each additional disease, and the maximum payment limit of the annual pooled fund is 3,000 yuan. The minimum payment standard and the maximum payment limit for outpatient chronic diseases of urban employees are calculated separately in a natural year, and are not combined with the annual maximum payment limit for hospitalization.
2. Basis for handling and application materials
Diagnosis data of the attending doctors of the second level and above public medical insurance agreement designated hospitals (some diseases need to be designated hospitals of the third level) and the state with outpatient special diseases and chronic disease recognition qualifications of the second level and above private medical insurance agreement designated hospitals) The diagnosis data of the attending doctor and above who are diagnosed with relevant diseases, including diagnosis certificates, discharge certificates, discharge summaries, discharge records, etc., one of the above diagnostic materials can be used.
3. Cancel the review of outpatient special diseases and chronic diseases
From August 1, 2023, the review of all outpatient special diseases and chronic diseases will be cancelled.
Insured persons who have registered for the recognition of outpatient special diseases and chronic diseases-related diseases shall still be valid after participating in the insurance across the overall planning area in the province, and do not need to re-apply for identification.
Fourth, the application channel
In the case of retaining the existing offline application channels, new online application channels will be added.
(1) Offline application channels.
1. Authorized and licensed designated medical institutions, including designated medical institutions in the state and designated medical institutions in the province outside the state;
2. Medical insurance business windows of medical insurance agencies at all levels.
(2) Online application channels
1. "Yunnan Medical Insurance" WeChat or Alipay mini program;
2. Yunnan Provincial Government Affairs Integration Service Platform;
3. "One mobile phone to do everything" mobile APP;
4. Medical insurance public service personal network hall. For details, see how to do it below:
"Yunnan Medical Insurance" WeChat/Alipay applet
Door slow door special operation steps
(1) Function introduction
The insured can register through the "Yunnan Medical Insurance" WeChat/Alipay applet;
(2) Operational steps
1. Open WeChat/Alipay and search for Yunnan Medical Insurance ==> click on my ==> jump out of authorized login ==> authorization login is successful.
2. Click [Service] to enter the handling page, and click the [Door Slow Door Special Registration] function; Fill in the registration information of the door slow door, with "*" items are required, and after filling in; Click [Letter of Commitment] and sign to confirm; Then upload the diagnosis certificate issued by the hospital and click Submit. Then wait for review.
The Yunnan government service network carried out the registration of the slow door
(1) Function introduction
The insured shall register through the "Yunnan Provincial Government Affairs Integration Service Platform";
(2) Operational steps
1. Enter the URL in the browser https://zwfw.yn.gov.cn/ enter the Yunnan government service network
2. Click the [Login] button above to jump to the login page; Sign in with your phone verification code
3. Enter your mobile phone number and the obtained verification code, and then click the [Login] button
4. Find the "Provincial Medical Insurance Bureau" in the direct department, click [Service] above, and then click [Personal Service]
5. Find the service item [Basic Medical Insurance Insured Personnel Enjoy Outpatient Chronic Disease Treatment Identification] and click [Online Processing]
6. Fill in the relevant information on the new page, and the items with "*" are mandatory
7. Click [Click to generate] the e-pledge, and click [Confirm] to upload the e-pledge
8. Click [Upload Materials] to upload the diagnosis certificate issued by the hospital
9. Click the [Submit] button to upload the door for registration, and wait for review
Through the "One Mobile Phone to Do Everything" mobile APP
Carry out the registration of the door slow door
(1) Function introduction
The insured person can register through the mobile APP of "One Mobile Phone Service";
(2) Operational steps
1. Search for "One Mobile Phone Everything" in the app store or mobile browser and download it
2. Open the "One Mobile Phone Service" APP, click [My] at the bottom right to enter the [My] page, and click the [Login] button to log in through WeChat with one click
3. After logging in, click the [Personal] button below, click the [Search Bar] in the middle of the [Personal] page to enter the search page, enter "Door Slow Door" in the search bar to search, and click the [Door Slow Door] function below
4. Fill in the registration information of the door, with "*" items are required, and fill in the information after completion; Click [Letter of Commitment] and sign to confirm; Then upload the diagnosis certificate issued by the hospital and click Submit. Then wait for review
Medical insurance public service personal network hall handling
(1) Procedures for individual registration
1. Click "Register" - "Individual Registration" in the upper right corner of the interface;
1 Public Service Portal
2. Enter the "Individual Registration" page, complete the filling according to the information prompts, agree to the "Agreement" and click [Register] to register successfully
Figure 2: Individual registration
(2) System login
Users can log in to the system by entering the correct username, password, and verification code, and perform the corresponding operations
Table 4: System login features
(3) Real-person authentication
1. When you log in by entering the account and password at the time of registration, you will be prompted for real-person authentication. Click Verify Now
2. According to the prompts, enter "Name" and "ID Number". Click [Authenticate]
3. Scan the QR code on WeChat for face authentication, after scanning the authentication. Click "I'm verified"
(4) Personal login
1. Click "Personal Hall Login" on the right side of the interface
Figure 6: Public Service Portal
2. Enter the account, password, and graphical verification code, and click [Login] to log in successfully
Figure 7: Log in with your personal account
(5) Door slow door special registration operation steps
1. Click on the "Personal Network Hall Login" entrance to jump to the "Personal Account Login" function.
2. Enter the account, password and verification code in the "Personal Account Login" function, and click the "Login" button.
3. Click "Enter Personal Hall" on the redirected page.
4. Click on the "What I want to do" list on the left side of the personal network hall page, and select the "Door Slow Door Special Registration" function in the drop-down box.
5. Fill in the relevant information in the "Door Slow Door Special Registration" (Note: the items with red stars are required, and the rest are optional).
6. In the "e-Pledge" column, click the blue "Click to Generate" button to generate an e-pledge and click the pop-up "Submit" button to upload the e-pledge.
7. Click the blue "Click Upload" button in the "Upload column" of the material to upload the material (diagnosis certificate issued by the hospital).
8. Click the blue "Submit button" at the bottom right to submit the registration and wait for the review of the Health Insurance Bureau. (Note: You can check the review progress in the "Inquiry of Items to be Reviewed" and "Reviewed Data Information" under the "I want to check" list).
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Step two
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Step 5 to Step 8
Queries on data to be reviewed and queries that have been reviewed
Editor: Mao Huan