The scope of medical insurance reimbursement includes:
1, medical expenses during rescue
2. Medical expenses during hospitalization
3, surgical materials and AIDS
4. Bed fee: according to local medical insurance standards. Except for those who need to stay in ICU (intensive care unit) because of acute craniocerebral injury and complex visceral injury coma, they should be transferred to the general ward immediately after they are out of danger.
5. Rehabilitation physiotherapy fee: according to local medical insurance standards. In principle, there are no more than three kinds, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated.
6, dressing change and rehabilitation function guidance training: according to the local medical insurance standards combined with the needs of the disease.
7. Ambulance fee: calculated according to the standard approved by local health department and price department.
8. Other expenses: expenses that are not compensated according to regulations will not be compensated.
9. Continuing medical expenses: In order to close the case in advance, the insured can pay the necessary continuing medical expenses for the injured in the future in advance. Only when the discharge certificate or diagnosis certificate clearly indicates that the competent doctor needs to continue treatment, or the internal fixator is removed after half a year or one year, or the follow-up treatment expenses are reviewed or recorded regularly, and the compensation payment voucher provided by the insurance record for the follow-up expenses can be reviewed. According to the needs of the disease, obviously beyond the needs of the disease, the audit fee for continuing medical treatment will not be compensated.
What are the non-disease treatment items for medical insurance reimbursement?
1, various cosmetic plastic surgery projects: such as acne, scar cosmetic, laser cosmetic, cosmetic tooth washing, hair transplant, etc.
2. Orthopedic treatment items: stuttering, dentition disorder, denture restoration (including post crown, crown fitting, denture installation), dental implantation, nasal snoring surgery (except respiratory distress), flat feet and other items (except congenital torticollis, cleft lip and palate, sequelae of polio).
3. Various bodybuilding treatment items: such as losing weight, gaining weight and increasing height.
4. Various physical examination items: such as employee physical examination and disease investigation.
5. Various preventive and health care projects: such as vaccination and fitness.
6. Various medical consultation and health prediction diagnosis and treatment items: such as various disease consultation fees (except psychological consultation conducted by secondary and tertiary mental health prevention and control institutions), including pulse meter, microcirculation tester, meridian diagnostic instrument (including computer diagnostic instrument of traditional Chinese medicine) and vital information diagnostic instrument.
7. Various medical appraisal items: such as labor ability appraisal (diagnosis and appraisal of workers' labor, work-related injuries and occupational diseases), judicial appraisal of mental patients, medical accident appraisal, and various inspection expenses.
To sum up, the scope of medical insurance reimbursement is relatively broad, including not only some expenses incurred by ordinary treatment, but also some expenses incurred by non-disease treatment. In some cases, it can be reimbursed, but there are also many expenses that are not paid by basic medical insurance, such as transportation expenses, first aid expenses, and nursing expenses.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 27
Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.