First get outpatient chronic special-disease certification, then file for care away from home, and hypertension, diabetes, outpatient chemo or radiotherapy, dialysis, and anti-rejection treatment can be settled directly in another region
Grade ABig benefitMoneyFreeLittle timeNo willpower
Hypertension, diabetes, outpatient chemo or radiotherapy for a malignant tumor, dialysis for uremia, and anti-rejection treatment after an organ transplant: for these, outpatient care away from home can in most cases be paid directly by insurance. You do not pay first and then claim it back where you are insured. You must first get outpatient chronic special-disease certification where you are insured, then file for care away from home. It works only if both are done.
- Cost
- No cost. Before you set out, file once for care away from home on the yibao (basic medical insurance) app. It can be done on a phone.
- Benefit
- A document from the National Healthcare Security Administration (国家医保局) says this has already been reached. The original wording is: "Cross-province direct settlement of outpatient costs for 5 outpatient chronic special diseases, including hypertension, diabetes, outpatient chemo or radiotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplant, is basically accessible at county level." "Accessible at county level" (县域可及) means it can be handled at county level. On top of these 5, the document adds another 5
- Notes
- Both have to be done: first get outpatient chronic special-disease certification where you are insured, then file for care away from home. How far the 5 newly added diseases have opened differs by place; follow what the local insurance authority publishes. If the hospital does not stock the negotiated drug you need, see section 24, item 13 (dual-channel designated pharmacies).
Sources · 1
- 国家医保局办公室、财政部办公厅 (2024). 关于稳妥有序扩大跨省直接结算门诊慢特病病种范围的通知（医保办发〔2024〕19 号）. gov.cn/zhengce/zhengceku/202409/content_69744…