Objective To analyze the current status of health insurance policies for outpatient chronic diseases among urban and rural residents in Sichuan Province and provide policy recommendations for improving their management. Methods Health insurance policies for outpatient chronic diseases across 21 coordination districts in Sichuan Province were systematically reviewed by computer. Descriptive analysis was employed to compare differences in disease coverage, classification management, eligibility criteria, and benefit levels. Results In Sichuan Province, the number of outpatient chronic and special diseases across its 21 coordination areas ranged from 41 to 77. The coverage of these diseases varies included <10%, 10%–49%, 50%–99%, and 100%, and the diseases were managed under 2, 3, or 4 categories. There were also significant variations in disease recognition criteria and the level of benefit protection among the different coordination areas. Conclusions Significant disparities exist in outpatient chronic diseases policies and management practices among the 21 coordination districts in Sichuan Province. To address this, we recommend standardizing the provincial outpatient chronic diseases catalog, eligibility criteria, and classification management. Additionally, benefit levels should be optimized and regional disparities gradually reduced under the premise of maintaining balanced medical insurance fund risks.