Secondary reimbursement for chronic diseases

The essence of the secondary reimbursement for chronic diseases that we often talk about is supplementary protection for the high and compliant out-of-pocket expenses of the chronically ill people after the basic medical insurance is reimbursed. The core premise is that they hold a valid chronic disease certificate and the annual cumulative compliant out-of-pocket expenses exceed the local threshold. The reimbursement funds usually come from critical illness insurance, medical assistance or local supplementary medical insurance for the benefit of the people. Not all patients with chronic diseases can enjoy it, and the rules vary greatly from place to place.

I just finished this reimbursement last month for Aunt Zhang, who has been suffering from type 2 diabetes for 8 years in the community. She was admitted to the hospital twice last year to adjust her blood sugar. In addition to the medicines prescribed by designated hospitals and the cost of regular glycated hemoglobin checks, after the basic medical insurance was fully reported, she spent 27,800 out of her own pocket. It was just over the 18,000 yuan threshold for secondary reimbursement for chronic diseases in the local residents’ medical insurance. Finally, I quoted another 6,000 yuan at a rate of 60%. When the account arrived, my aunt pulled me and insisted on giving me half a bag of pickled sugar garlic, saying that the money was just enough for her to buy insulin for more than half a year.

Many people may be wondering: I also have a chronic disease certificate, why have I never received this money? This is actually the most controversial aspect of secondary reimbursement for chronic diseases at present - there is no unified implementation standard across the country, and each locality formulates its own rules based on its own medical insurance fund's ability to bear pressure. When I was on a business trip in Suzhou, I talked to friends in the local medical insurance industry. The threshold for secondary reimbursement of chronic diseases under the local employee medical insurance is only 8,000, and the co-payment for outpatient medicines can also be accumulated, including medicines purchased at designated pharmacies with chronic disease certificates. ； However, in a prefecture-level city in the northwest of my hometown, currently only people with chronic diseases such as subsistence allowances, extreme poverty, and those who have returned to poverty or become poor can enjoy secondary reimbursement. People with chronic diseases under ordinary residents' medical insurance have to pay more than 30,000 out-of-pocket to apply for it. Many elderly people who take medicine all year round pay just over 20,000 out-of-pocket a year. It is really a pity that they are stuck outside the threshold.

The medical insurance circle has been arguing for many years about how to set this threshold. One group believes that chronic diseases themselves are long-term rigid expenses, and the threshold for secondary reimbursement should be lowered. It is best to cancel the deductible so that more ordinary people with chronic diseases can enjoy the benefits. ； The other group is worried that if the threshold is too low, some people will prescribe and resell drugs under false names. The already tight medical insurance fund must first cover people with serious illnesses. Both statements are actually reasonable. At present, various places are slowly making pilot adjustments. For example, many places have lowered the secondary reimbursement threshold for chronically ill people to less than 50% of the per capita disposable income of local residents this year, which is much friendlier than in previous years.

To be honest, I have been exposed to so many cases, and many people failed to apply not because they did not meet the conditions, but because they stepped on the trap themselves. Not long ago, an old man came to me and said that he had been suffering from high blood pressure for more than ten years. He spent more than 20,000 yuan on medication a year and had never claimed a second reimbursement. After checking, I found out that his chronic disease certificate had forgotten the annual review last year and immediately expired. All the expenses that year were not included in the chronic disease benefits. He did not even enjoy the chronic disease outpatient reimbursement of the basic medical insurance, let alone the secondary reimbursement. He lost thousands. There are also many people who want convenience when buying chronic disease medicines. They can just find a drug store and buy them. They do not go through the chronic disease certificate settlement and directly swipe their personal accounts. These expenses are not included in the compliance accumulation, and they will naturally not reach the deductible by the end of the year.

However, it is much more convenient to apply for it now than before. In the past two years, I had to go to the medical insurance bureau with a stack of invoices to help others. Now in most places, you can apply directly on the national medical insurance service platform APP or the local medical insurance applet. After uploading the fee voucher, it can be received in two or three days. Many places have even implemented "one-stop settlement". When you check out at the hospital, you will be reported directly, and you do not have to apply yourself, which saves a lot of things.

In fact, to put it bluntly, secondary reimbursement for chronic diseases is a small benefit left by the state for people with chronic diseases. You don’t have to always feel that “good things don’t happen to me.” Spend two minutes calling the 12393 medical insurance hotline, or go to the community medical insurance service post to ask a few questions to see what the local rules are. Maybe you can still reimburse last year’s expenses? After all, it’s all the medical insurance money you pay, so don’t waste the benefits you can enjoy.