Bork In most cases, the reimbursement amount and proportion of special chronic diseases are higher than those of ordinary chronic diseases. However, this conclusion is not absolute. It ultimately depends on the specific policies of your insured place and your own disease classification.
Many people may be confused about the relationship between the two and think they are two completely independent types of diseases. In fact, the full name of chronic special disease is chronic special disease, which itself is a "key concern" in the category of chronic diseases. It is screened for diseases that have a longer course, higher treatment costs, require long-term dependence on specific drugs or treatments, and have a greater impact on life. Medical insurance will naturally give more policy preferences to these patients, and it is normal for higher reimbursement benefits.
I came across a very intuitive comparison last year when I helped my distant cousin register for chronic disease registration in another place. She was covered by Shandong residents’ medical insurance. She had ordinary type 2 diabetes without complications. She applied for a general chronic disease qualification. The annual outpatient reimbursement cap is 2,000 yuan, and she can reimburse 60% of the expenses within the overall planning scope.； An aunt in the same clinic has diabetes combined with kidney disease. It happens to be in the local list of chronic diseases. The annual cap is 60,000 yuan, and the reimbursement rate can reach 80%. Even relatively expensive medicines such as insulin analogues, which are usually used, are also on the reimbursement list for chronic diseases. The difference between the two in the annual reimbursement is dozens of times.
Of course, not all cases require chronic diseases to be reimbursed more. I have encountered exceptions when I volunteered to promote medical insurance policies in the community: In order to improve the protection of common chronic diseases, the local government raised the reimbursement rate to 75% for patients with common chronic diseases such as hypertension and diabetes who signed a contract with a family doctor, and the annual limit was also raised to 5,000 yuan.； For some chronic diseases with relatively stable conditions and low treatment costs, such as chronic urticaria, the local annual limit is 3,000 yuan and the reimbursement rate is 70%. In this case, the reimbursement treatment for ordinary chronic diseases is better.
In fact, this difference is normal. At present, there is no unified catalog of chronic diseases and chronic special diseases in the country. Each coordinating region determines it based on the affordability of the local medical insurance fund and the incidence rate of local diseases. Even the policies of different cities in the same province may be different. In addition, the benefits of employee medical insurance and resident medical insurance are inherently different. For the same disease, whether it is a common chronic disease or a chronic special disease, the reimbursement ratio and limit of employee medical insurance are much higher than that of resident medical insurance.
Oh, by the way, if you have a diagnosis certificate for a chronic disease in your hand, don’t just listen to other people’s opinions about which one is more reimbursed. Directly search the official account of the local medical insurance bureau, or go to a community medical insurance service point near your home and ask a few questions to see if your disease can be included in the chronic disease directory. Just do your best to get it. After all, in most cases, the protection for chronic special diseases is indeed much looser. I have seen several patients with rheumatoid and systemic lupus erythematosus. After getting treatment for chronic special diseases, their annual out-of-pocket drug expenses can be reduced by tens of thousands, and the pressure is much less.
