I. Category I Special Outpatient Diseases

(1) Category I Diseases Recognizable and Treatable in Our Hospital

Malignant tumor (chemotherapy including biotargeted therapy and endocrine therapy); chronic renal insufficiency (hemodialysis); six major types of mental illnesses.

(2) Benefit Entitlements for Category I Special Outpatient Diseases

1. Medical treatment is available at designated municipal medical institutions qualified for special outpatient disease services. Participants certified with chronic renal insufficiency (hemodialysis) or chronic renal insufficiency (peritoneal dialysis) shall select one designated treatment institution.

2. Participants with continuous insurance coverage for 36 months or longer are eligible for special outpatient benefits starting from the application date; those with less than 36 months of continuous coverage shall enjoy benefits upon approval by the Shenzhen Municipal Medical Insurance Bureau.

3. Reimbursement ratios:

- 60% for participants with continuous coverage less than 12 months

- 75% for participants with continuous coverage of 12 to 35 months

- 90% for participants with continuous coverage of 36 months or longer

II. Category II Special Outpatient Diseases

(1) Category II Diseases Recognizable and Treatable in Our Hospital

Hypertension, diabetes mellitus, chronic obstructive pulmonary disease, coronary heart disease, sequelae of cerebrovascular diseases, chronic cardiac insufficiency, chronic hepatitis B, bronchial asthma, Parkinson’s disease, epilepsy, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, psoriasis, decompensated liver cirrhosis, macular edema secondary to retinal vein occlusion, malignant tumor (non-radiotherapy and non-chemotherapy), wet age-related macular degeneration, diabetic macular edema, choroidal neovascularization, hepatitis C, acromegaly, multiple sclerosis, pulmonary arterial hypertension, chronic renal insufficiency (non-dialysis treatment).

(2) Benefit Entitlements for Category II Special Outpatient Diseases

1. Hypertension & Diabetes Mellitus

- Treatment at designated community health service centers with contracted family doctors: 90% pooling fund reimbursement

- Treatment at selected designated general outpatient pooling institutions: reimbursement follows general outpatient pooling ratios (55% at main hospital campus, 75% at community health centers), and expenses count toward the annual payment cap for special outpatient diseases.

2. Other Category II Diseases

Participants shall select one designated medical institution with special outpatient disease service qualifications for treatment.

- Employee Tier 1 Medical Insurance: 80% reimbursement

- Employee Tier 2 Medical Insurance & Resident Medical Insurance: 60% reimbursement

For chronic obstructive pulmonary disease, coronary heart disease, sequelae of cerebrovascular diseases, rheumatoid arthritis, bronchial asthma and chronic hepatitis B, participants may also receive treatment at contracted community health service centers with an 80% reimbursement ratio.

Important Note

Each disease (including hypertension and diabetes mellitus) has an independent annual maximum payment limit. Separate limits apply to Employee Tier 1, Employee Tier 2 and Resident Medical Insurance participants, and these limits are not combined with the general outpatient pooling annual cap.

III. Required Documents & Application Procedures for Special Outpatient Disease Registration

(1) Required Documents

1. Medical records, disease diagnosis certificate, discharge summary, pathological report, and relevant examination/test reports issued by the diagnosing hospital.

2. Original ID card and social security card of the participant.

(2) Handling Procedures

1. Bring all medical documents to the corresponding specialist outpatient clinic for consultation.

2. After verifying eligibility, the attending specialist fills out the Application Form for Special Outpatient Disease Benefit Certification. Note: the attending physician and the reviewing senior physician must sign separately (same signature is invalid).

3. Submit all documents together with the completed application form to the Medical Insurance Service E-Station on the 1st Floor, Building 3 for review and processing.