I believe everyone has heard that many anti-AIDS drugs have entered the medical insurance or reduced the price, so far many people do not know that these drugs can be reimbursed by medical insurance, so this article will be interpreted in detail!
The meaning of the dual channel of medical insurance:
To put it simply, "dual channel" refers to two ways to buy drugs: designated hospitals and designated pharmacies, which are also collectively referred to as designated medical institutions by medical insurance.
The role of the dual channel of medical insurance:
Through the "dual channel", the medical insurance department ensures that patients can buy negotiated drugs that have been included in the medical insurance, and at the same time, it ensures that patients can enjoy medical insurance reimbursement treatment when purchasing negotiated drugs in designated medical institutions, and the reimbursement policy is consistent.
Which kind of medical insurance can enjoy dual channel?
Resident medical insurance (NCMS has been merged with resident medical insurance): It is the kind that pays 380 yuan a year.
Employee medical insurance: that is, there is a unit, there is a formal job, and the unit registers with the social security department.
Who can enjoy the dual channel of medical insurance to purchase anti-AIDS drugs?
People living with HIV (PLWH) who have purchased both domestic and employee health insurance.
How to apply?What information do I need to apply?
Step 1: Make a request to your record manager or case manager and develop a plan based on your personal circumstances
Step 2: Prepare the materials, such as the ones prepared by my city as follows:
The materials prepared in each region are different, but they are similar and subject to the requirements of the location.
Step 3: After the application for the dual channel of medical insurance is successful, first find a doctor to issue a prescription, and then purchase it directly from a designated hospital or designated pharmacy (only need to pay the self-pay part).
Step 4: You need to apply for the dual channel of medical insurance once a year, so prepare an extra copy when preparing the materials for the first time.
Zhuzhou City Medical Insurance Dual Channel Application Information and Process.
About privacy
Theoretically, the use of medical insurance must be paid by the person and will not disclose privacy. However, it is good to pay attention to protecting personal privacy during the application process and drug purchase process, some units have better benefits, and when it comes to the second unit reimbursement, you may have to check the invoice and medical records, which may involve privacy issues.
What about out-of-town medical insurance?
For example, in the first case, the patient works in place A, the HIV management is in place A, and the health insurance is in place B.
The second situation: the patient works in place A and receives the medicine in place B, what should I do in this situation?
First of all: the so-called dual channel of medical insurance, you must figure out which region of the medical insurance you are buying, and you can only apply for the medical insurance in the region where you are located. Let's look at the first scenario: the patient works in place A, the HIV management is in place A, and the health insurance is in place B. Then the PLWH needs to find a doctor in area A to issue a certificate and prepare all the information, and then go to the medical insurance bureau in place B to apply, and after the application is successful, buy it at the designated hospital or pharmacy in place B, or buy it in the hospital or pharmacy in place A and keep the invoice, and go to the medical insurance bureau in place B for reimbursement.
The second situation: still go with the medical insurance, this PLWH needs to go back to place B once a month and receive a month's worth of medicines.
What should I do with medical insurance outside the province?
For example, if the patient works in province A, the medical insurance is in province A, and the management of HIV is in province B, the easiest way is to migrate the HIV management file to province A and use the medical insurance in province A to pay.
Secondly: the patient works in province A, the medical insurance is in province B, and the management of HIV is in province B, which is more troublesome because it involves inter-provincial conditions, and many provinces have not carried out outpatient co-ordination and docking, so this situation is difficult to handle, and the cost of travel is high and not cost-effective.
Can I be reimbursed if I don't have resident medical insurance and HIV management files?
No, you can't!In this case, you can only pay for yourself, but in 2024, the price of many drugs will be reduced, and patients with better financial ability will be much less stressed.
Is there any benefit to entering the dual channel of medical insurance?
First: enjoy imported drugs or single-tablet compound preparations (one tablet a day), do not worry about drug quality problems, regular follow-up;
Second: save money, you can save more than 7,000-10,000 a year.
Is there any difficulty in entering the dual channel of medical insurance?
First: At present, most areas can only receive one a month, and it takes more energy to spend more energy on the road;
Second: Many designated hospitals do not work on weekends and need to take leave to receive medicine, and they have to take half a day off a month
Third: As for the privacy issue, as mentioned above, pay attention to protecting privacy during the application process and the purchase process.
Latest medicines**, as shown in the picture).
I hope that in the future, the dual channel of medical insurance can be like chronic disease management, and you can prescribe drugs for 3 months at a time (it needs to be approved by the Medical Insurance Bureau).
Reminder: It's about to enter 2024, have you paid your 380 yuan?There are still a few days left, please renew it in time!