Who knows the calculation method of Huizhou medical insurance reimbursement?

Social basic medical care is a basic medical insurance system that integrates the basic medical insurance for urban workers and the new rural cooperative medical care system, and is organized and implemented by the Municipal People's Government, with unified system, unified policy and unified management, including basic medical insurance for urban workers and basic medical insurance for residents (hereinafter referred to as employee medical insurance and resident medical insurance).

(1) Employee medical insurance is compulsory social insurance of the government. Organs, institutions, social organizations, enterprises, private non-enterprise units, individual industrial and commercial households and other organizations (hereinafter referred to as employers) within the administrative area of this Municipality shall participate in employee medical insurance for all employees (including retirees) in accordance with the principle of territorial management. Flexible employees, social retirees and employees from Hong Kong, Macao and Taiwan who apply for employment registration in this Municipality can participate in employee medical insurance.

(2) Residents' medical insurance is a medical insurance system organized by the government, which combines individual contributions with financial subsidies. Including:

1, residents of this city (including urban and rural household registration, the same below) except those who should participate in employee medical insurance according to regulations;

2. Full-time students and part-time graduate students who receive general higher education in various colleges and universities in this city.

3 employees of state-owned and collective enterprises with difficulties in production and operation.

The insured can only participate in one kind of social basic medical insurance and enjoy the corresponding medical insurance benefits in the same period of time.

What is the payment standard of employee medical insurance?

Medical insurance for employees includes comprehensive basic medical insurance, hospitalization basic medical insurance, supplementary medical insurance and Medicaid for civil servants. Pay medical insurance premiums according to the following provisions:

(1) Employees of all organs, institutions and social organizations, employees of enterprises over 30 years old (including 30 years old), employees of private non-enterprise units and individual industrial and commercial households must participate in comprehensive basic medical insurance. Medical insurance premiums shall be paid jointly by the employer and the employees. The employer shall pay 6.5% of the total wages of employees participating in the comprehensive basic medical insurance, and the employees shall pay 2% of their average monthly wages. If the total average monthly salary of employees is lower than 60% of the average monthly salary of employees in the city last year (hereinafter referred to as the average monthly salary of employees in the city last year), it shall be approved according to 60% of the average monthly salary of employees in the city last year. The total average monthly salary of employees is higher than 300% of the average monthly salary of employees in the whole city in the previous year, and the medical insurance premium of employees is not paid for the higher part.

Employees of enterprises, private non-enterprise units and individual industrial and commercial households under the age of 30 may choose to participate in comprehensive basic medical insurance or hospitalization basic medical insurance according to the actual situation. To participate in the basic medical insurance for hospitalization, the medical insurance premium shall be paid by the employer at 2% of the social wage of this Municipality in the previous year, and the individual employees shall not pay it.

Flexible employees who choose to participate in employee medical insurance can choose to participate in comprehensive basic medical insurance or hospitalization basic medical insurance. To participate in the comprehensive basic medical insurance, individuals pay 8.5% of the city's annual social wages on a monthly basis; To participate in the basic medical insurance for hospitalization, individuals pay 2% of the city's social wages in the previous year on a monthly basis.

(two) all employees who participate in medical insurance must participate in supplementary medical insurance and pay supplementary medical insurance premiums. Employers (including flexible employees) pay 1% of the city's social wages in the previous year on a monthly basis.

What are the rules for retired employees to participate in employee medical insurance?

Retirees who participate in employee medical insurance shall choose one of the following payment methods to pay employee medical insurance premiums.

(1) One-time payment: The unit chooses to pay the employee medical insurance premium for 10 anniversary at a one-time rate of 7.5% based on the social wage of this city in the previous year, with an annual increase of 10% (including supplementary medical insurance).

(2) Monthly payment: based on the salary paid by retirees themselves (if the salary paid by retirees is lower than the social salary of last year in this city, it will be calculated according to the social salary of last year in this city, the same below), and the employer will pay the monthly payment at the rate of 7.5% (including supplementary medical insurance) until the retiree dies.

(three) the social bid for retirees to participate in employee medical insurance, according to the payment methods stipulated in items (1) and (2), choose to pay the employee medical insurance premium in one lump sum or on a monthly basis.

If the insured employees who have paid monthly fees at retirement need to pay a one-time fee, the payment period of their medical insurance for retired employees shall be calculated as one-time payment period.

What is the payment standard of residents' medical insurance?

Residents' medical insurance takes the family as the insured unit. Members who meet the conditions of insurance in a household registration book must be insured at the same time according to the same payment grade. The following payment standards can be selected according to the actual situation of the family: A file: 20 yuan per person per year; B file: 30 yuan per person per year; File C: per person per year 120 yuan;

Enjoy the minimum living guarantee, the rural "five guarantees", the urban "three noes" (the urban has no economic resources, no ability to work and no dependents), other residents with special difficulties confirmed by the municipal and county (district) people's governments, and all kinds of first-and second-grade disabled residents join the resident C file with their families, and the individual contributions are partly borne by the local county (district) finance.

Central, provincial, municipal and county (district) financial subsidies for residents' medical insurance are directly included in the residents' medical insurance fund. The municipal finance subsidizes 20 yuan every year, and the county finance subsidizes 15 yuan every year.

How to participate in social basic medical insurance?

(a) the insured employees (including flexible employees who participate in employee medical insurance) shall be declared and registered by the unit to the local tax and social security agency in the place of business or industrial and commercial registration, and shall be declared and paid to the local tax department every month according to the regulations.

(two) the insured residents take the family as the insured unit, and the members who meet the insurance conditions in the same household registration must be insured at the same time according to the same payment grade; Residents' medical insurance premiums shall be paid according to the natural year.

1. The villagers' committee is responsible for handling insurance for residents within its jurisdiction. Families should fill in the Registration Form of Huizhou Residents' Basic Medical Insurance, and the villagers' committee will collect medical insurance premiums. When residents take the family as the unit to participate in the insurance, they should provide the household registration book and a copy to the social security agency or the social security office, and fill in the Registration Form of Huizhou Residents' Basic Medical Insurance to handle the insurance registration procedures.

2. When the poor people participate in residents' medical insurance (participate in file C), they should participate in residents' medical insurance with their families on the strength of valid certificates issued by civil affairs departments at or above the county level or disability certificates issued by the Disabled Persons' Federation (only for all kinds of disabled people).

How to pay after insurance?

(a) medical insurance premiums for employees are collected by the local tax authorities; Individual contributions are withheld and remitted by the employer from the employee's salary every month.

(two) residents' medical insurance premiums shall be collected by social security agencies.

If the villagers' committee pays the insurance premium on its behalf, the villagers' committee shall pay the residents' medical insurance premium to the charging unit designated by the social security agency after going through the insurance registration formalities.

Residents who apply for insurance payment by family as a unit shall pay residents' medical insurance premium at the charging unit designated by the social security agency with the payment voucher uniformly printed by the social security agency or the social security agency.

Social security agencies or social security offices should be insured residents who pay insurance premiums, and issue insurance certificates on a household basis.

Those who participate in residents' medical insurance shall pay the medical insurance premium for the next year from September 1 day to February 3 1 day; If the information is changed, the medical insurance premium shall be paid after handling the information change procedures.

This year's new insured residents should pay the medical insurance premium of that year.

How to pay the basic medical insurance for urban residents?

Those who originally participated in urban residents' medical insurance shall pay the residents' medical insurance fee from July 1 to February/2009 (i.e. 1 half a year's medical insurance fee: calculated according to the payment grade I choose) 20 11,and pay the residents' medical insurance fee according to the natural year (20 yuan and 30 yuan)

When will the insured begin to enjoy medical insurance benefits after payment?

Insured employees and insured residents who pay insurance premiums this year will enjoy medical insurance benefits according to regulations from the next month of insurance payment.

Insured residents who pay the medical insurance premium for the next year within the specified payment time shall enjoy the medical insurance benefits according to the provisions of these Measures from 1 day of the next year.

The insured person shall stop enjoying medical insurance benefits from the month following the unpaid medical insurance premium.

What are the rules for changing information after entering school?

In any of the following circumstances, the insured person shall go through the formalities of change at the local tax department, social security agency or social security office in time:

(a) to participate in employee medical insurance, and the employer terminates or terminates the labor relationship, the employer shall, within 20 working days after the employee terminates the labor relationship, go through the relevant procedures for terminating the medical insurance relationship with the local tax department and the social security agency.

(II) Residents who participate in residents' medical insurance participate in employees' medical insurance after employment or participate in employees' medical insurance as flexible employees should go through the formalities of stopping residents' medical insurance at the social security agency or social security office in the insured area before handling employees' medical insurance, and the paid residents' medical insurance fees will not be refunded.

(III) After participating in employee medical insurance or resident medical insurance, the employer or family members shall, within 20 working days, go to the local tax department and social security agency (or social security office) where the household registration is located with the "Notice of enlistment" issued by the conscription office of the local government. The new renewal (participation) time of retired soldiers is calculated from the time when they are approved to leave active service. Demobilized veterans shall go through the formalities of renewal (participation) insurance payment within 3 months after being approved to leave active service, and their active service time shall be regarded as the continuous payment time of employee medical insurance or resident medical insurance. Those who apply for renewal (participation) insurance after more than 3 months are regarded as new insurance, and their service time is not included in the continuous payment time.

(four) families participating in residents' medical insurance need to change the payment grade, and should go through the formalities for changing the payment information for the next year at the local villagers' committee, social security office or social security agency from September to February of the following year.

How to choose general outpatient medical institutions?

Insured persons need to choose a township health center (including administrative village health station) or community health service center (collectively referred to as primary health service institutions) from July to September 2009. Insured employees can choose a designated hospital as the first outpatient medical institution (hereinafter referred to as the designated outpatient institution) from June 5438+ 10/day, 2009, and enjoy outpatient treatment according to regulations. After the insured chooses a designated outpatient institution, the employer or individual shall register with the social security agency or the social security office; I can also register in a designated institution and fill in the Registration Form of Basic Medical Insurance for Outpatients in Huizhou City.

How is the medical insurance treatment?

(1) outpatient treatment

1. For those who participate in the A file of residents' medical insurance, the payment standard of medical insurance fund is: the cumulative payment limit of 200 yuan per person per year; The proportion of single outpatient payment is 35%; The outpatient expenses referred by designated outpatient institutions (including emergency) to other designated medical institutions shall be paid at a rate of 25%; The limit of each payment is 12 yuan.

2. For those who participate in the B file of residents' medical insurance, the payment standard of medical insurance fund is: the cumulative payment limit of 300 yuan per person per year; The proportion of single outpatient payment is 40%; Outpatient service fees for referral to other designated medical institutions by designated outpatient institutions (including emergency departments) shall be paid at the rate of 30%; The limit of each payment is 20 yuan.

3. For those who participate in the C file of residents' medical insurance, the payment standard of medical insurance fund is: the cumulative payment limit of 600 yuan per person per year; The proportion of single outpatient payment is 50%; Outpatient fees for referral to other designated medical institutions by designated outpatient institutions (including emergency departments) shall be paid at the rate of 40%; The limit of each payment is 60 yuan.

4. For employees who participate in medical insurance, the payment standard of medical insurance fund is: the cumulative payment limit per person per year is 800 yuan; In first-class health service institutions, second-class and third-class hospitals, the proportion of single outpatient expenses paid by medical insurance fund is 75%, 50% and 40% respectively; Outpatient expenses referred by designated outpatient institutions (including emergency departments) to other designated medical institutions were reduced by 10 percentage point respectively; The limit of each payment is 120 yuan.

(2) Hospitalization

The hospitalization expenses incurred by the insured due to illness (including birth or termination of pregnancy in accordance with the family planning provisions of the residents' medical insurance, the same below) shall be paid by the medical insurance fund in accordance with the regulations in the part above the Qifubiaozhun. Qifubiaozhun is determined according to the level of the hospital, the first-level hospital 100 yuan, the second-level hospital 300 yuan, and the third-level hospital 500 yuan.

1. After the insured employees have continuously paid for 6 months (excluding 6 months), they go to designated medical institutions within the administrative area of this Municipality or transfer to designated medical institutions outside the administrative area of this Municipality for medical treatment, and the basic medical expenses that meet the requirements occur. The proportion of employee medical insurance fund payment is: 90% for on-the-job employees and 95% for retired employees. The proportion of fund payment is 75% for those who have not gone through the transfer procedures to the designated medical institutions outside the administrative area of this Municipality for hospitalization. For treatment in non-designated medical institutions outside the administrative area of this Municipality, the proportion of fund payment is 60%. For the insured employees who have paid for less than 6 months in a row, the basic medical expenses incurred by their hospitalization shall be uniformly paid by the fund at 60%. After the insured employees' basic medical expenses for hospitalization in that year meet the requirements and are reimbursed according to the regulations, 90% of the part that exceeds the maximum payment limit of the employee medical insurance fund will be paid by the supplementary medical insurance fund, and the individual pays 10%.

2 insured residents hospitalized due to illness, hospitalization basic medical expenses in accordance with the provisions. The payment standard of residents' medical insurance fund is (1) 75% for first-class hospitals, 55% for second-class hospitals and 40% for third-class hospitals. 2, to participate in the B file, 80% of the first-level hospitals, 60% of the second-level hospitals, and 45% of the third-level hospitals. (3), to participate in the C file, 85% of first-class hospitals, 75% of second-class hospitals, and 65% of third-class hospitals. (IV) The insured residents who have gone through the transfer procedures (including emergency treatment) go to the designated medical institutions outside the administrative area of this Municipality for hospitalization, and the basic medical expenses that meet the requirements shall be paid by the residents' medical insurance fund according to the standards of hospitals at the same level within the administrative area of this Municipality; For the basic medical expenses that meet the requirements of hospitalization in medical institutions outside the administrative area of this Municipality without transfer procedures, the payment ratio of residents' medical insurance fund will be reduced by 15 percentage points respectively (except for students studying in different places).

(3) Specific outpatient service

* * * There are 19 diseases, and they are entitled to corresponding treatment according to different payment standards.

(4) Medical insurance assistance

When the insured person is hospitalized due to illness during the year and the personal out-of-pocket expenses (excluding specific outpatient expenses) meet the following standards, he may apply for medical insurance assistance.

65,438+0. If the out-of-pocket expenses of the insured employees reach more than 5,000 yuan (including 5,000 yuan) to 1 10,000 yuan (including 1 10,000 yuan) during the year, the payment ratio is 40%; If the amount is more than 10000 yuan (excluding 10000 yuan), the payment ratio is 50%.

2. If the out-of-pocket expenses of the insured residents reached 3,000 yuan (including 3,000 yuan) or more to 10000 yuan (including 10000 yuan), the payment ratio was 40%; If the amount is more than 10000 yuan (excluding 10000 yuan), the payment ratio is 50%.

What are the rules for outpatient treatment and how to reimburse medical expenses?

The insured person should seek medical treatment at the designated outpatient institution. If the illness requires medical treatment in other designated institutions within the administrative area of this Municipality, the designated outpatient institutions shall go through the referral procedures in accordance with the regulations, produce the insurance certificate, and go through the medical treatment procedures after verification.

I only need to pay the part I should pay for medical treatment in the selected outpatient medical institutions, and the rest will be paid by the medical insurance fund according to the regulations. After referral (including emergency treatment) to other designated medical institutions within the administrative area of this Municipality for outpatient treatment, the medical expenses shall be paid in advance by the individual, and the insured person shall go through the reimbursement procedures with the disease diagnosis certificate, outpatient medical records, effective medical expense bills, detailed list of medical expenses and outpatient referral form to the designated outpatient institutions selected by him within 60 days from the date of treatment.

What are the rules for hospitalization and how to reimburse medical expenses?

If the insured person seeks medical treatment within the administrative area of this Municipality due to illness, he shall show his certificate of insurance and go through the medical treatment procedures after verification. Medical expenses shall be settled in the following ways.

(a) in the administrative area of the city and social security agencies computer networking designated medical institutions for medical treatment, individuals only need to pay personal fees; The part paid by the medical insurance fund shall be directly settled by the social security agency and the designated medical institution.

(II) If there is no computer connected to the Internet within the administrative area of this Municipality or if the patient is hospitalized (including emergency) in a medical institution outside the administrative area of this Municipality, the medical expenses shall be paid in advance by the individual, and within 60 days after the end of this medical treatment, the patient shall hold the disease diagnosis certificate, the original discharge summary, the original valid medical expenses document, the detailed list of medical expenses, the bank account number and the copy of his/her ID card (I don't have an ID card, so I need to provide a household registration book, so I need to provide transfer procedures, and students studying in different places need to provide the school

(III) If the insured residents are hospitalized in designated medical institutions due to childbirth or termination of pregnancy in line with the family planning regulations, their families should report to the social security agency or social security office in the insured area with their maternity ID card, marriage certificate, valid family planning certificate and the Declaration Form of Huizhou Residents' Basic Medical Insurance Maternity Treatment signed by the attending doctor within 7 days of hospitalization, and the hospital will make settlement according to the regulations with the Declaration Form of Huizhou Residents' Basic Medical Insurance Maternity Treatment confirmed by the local social security agency. Giving birth to children outside the administrative area of this Municipality shall be carried out in accordance with the provisions of the second paragraph of this article.

(four) the insured person is hospitalized due to illness within the administrative area of this Municipality, and when going through the discharge formalities, his family members shall sign the "Huizhou Social Basic Medical Insurance Hospitalization Expense Statement". For disputed medical expenses, the insured person has the right to inquire about the detailed items from the hospital.

15. What are the regulations for medical treatment in different places?

Students studying in different places and insured persons living or working in different places (continuous 1 year or more) should go through the registration procedures for medical treatment in different places.

(a) to live and work in different places, it is necessary to provide proof of the local community neighborhood Committee or villagers' Committee. Students studying in different places only need to go through the registration formalities with the school's admission notice or other valid certificates (including documents) at the social security agency or social security office in the insured area.

(2) The insured person shall go to the social security agency or social security office in the insured place to receive the Registration Form for Medical Treatment in Different Places of Huizhou Social Basic Medical Insurance, and choose 1 or two designated medical institutions for basic medical insurance at the place of residence (public medical institutions are selected where the basic medical insurance system is not implemented locally). After being confirmed by the seal of the selected medical institution and the local medical insurance agency (the level of the selected medical institution shall be indicated), it shall be submitted to the social security agency of the insured place for the record.

(three) the insured person in the selected medical institutions for medical treatment, the selected medical institutions for transfer to designated medical institutions outside the administrative area of this Municipality for medical treatment, according to the standards of designated medical institutions at the same level within the administrative area of this Municipality. Not transferred to non-selected medical institutions for hospitalization, in accordance with the relevant provisions of hospitalization.

(four) medical treatment in different places, outpatient medical treatment according to the designated outpatient institutions (including personal accounts of insured employees) included in my financial account. That is, medical insurance for employees is per person per year 156 yuan (per month 13 yuan), and medical insurance for residents in 20 yuan and files B, 30 yuan and C is per person per year 100 yuan.

How to apply for reimbursement for medical treatment in different places?

(1) Measures for reimbursement of medical expenses for emergency hospitalization in different places.

If the insured is hospitalized in an emergency in a medical institution outside the administrative area of this Municipality, the expenses shall be paid in advance by himself. Within 60 days after discharge, with the proof of disease diagnosis, valid expense documents, list of treatment expenses, copy of discharge summary, copy of bank account number and ID card (or copy of household registration book), go through the reimbursement procedures with the medical institutions entrusted by social medical insurance agencies or social medical insurance agencies. If a child is born outside the administrative area of this Municipality in this way, it is also necessary to provide proof of identity, marriage certificate and valid family planning certificate. Qifubiaozhun is determined according to the level of hospitals at the same level within the administrative area of this Municipality. Hospitals whose grades cannot be determined outside the administrative area of this Municipality shall be subject to the Qifubiaozhun of tertiary hospitals within the administrative area of this Municipality, and the medical expenses within the Qifubiaozhun shall be borne by the insured. If the insured person cannot provide reimbursement materials according to the above requirements, the social insurance agency will not accept it. The relevant information provided by the insured person lacks effective price information, and the cost standard is calculated with reference to the medical charge standard of our city.

If the emergency hospitalization outside the city needs to be transferred due to illness, it should be transferred back to the designated medical institutions in this city if the illness permits; If it is necessary to be transferred to a local medical institution, the transfer certificate and illness summary issued by the transferred medical institution should also be provided when handling the reimbursement procedures.

(2) Measures for reimbursement of medical expenses for hospitalization in different places.

1, the insured who has gone through the registration formalities for medical treatment in different places, his personal account and outpatient co-ordination amount will be transferred to him every year according to the regulations for outpatient medical expenses, and the overspending will not be covered;

2. When the insured person goes to the selected hospital for hospitalization, the expenses shall be paid in advance by himself. Within 60 days after discharge, with the proof of disease diagnosis, valid bills, list of treatment expenses, copy of bank account number and ID card or copy of household registration book, go through the reimbursement procedures at the local social medical insurance agency or the medical institution entrusted by the social medical insurance agency. Qifubiaozhun is implemented according to the standards of hospitals at the same level in our city, and the maximum payment limit of the basic medical insurance pooling fund is implemented according to the standards of our city.

How to apply for medical insurance assistance?

The insured shall, before June of the following year, transfer the medical insurance assistance to the applicant's financial account within 30 working days after the application form for Huizhou social basic medical insurance assistance submitted by the local social security agency or social security agency (in duplicate) is approved by the social security agency. The deadline for application is 65438+February 3 1 of the second year.

Eighteen, the insured employee personal account into the standard and scope of use?

The insured who participates in the comprehensive basic medical insurance shall establish a personal account.

(a) the personal account consists of the individual contributions of the insured employees and the unit contributions included in proportion according to different age groups. The specific classification criteria are: employees under 35 years old (including 35 years old) are classified according to 1% of their paid wages; Employees over 35 years old to 45 years old (including 45 years old) shall be counted as 65438+ 0.3% of the salary paid by them; Employees over 45 years of age before retirement are included in 2% of their payment wages; Retirees are included in 4.5% of their salary (one-time one-time payment is based on the social salary of this city last year). All the civil servants' medical subsidies paid by the employer for employees are included in my personal account.

(2) Personal accounts can be used to pay the medical expenses paid by the spouses, parents or children of the insured employees when they seek medical treatment in the designated medical institutions in this city, and the medical expenses that meet the policy requirements when they purchase medicines in designated retail pharmacies; The cost of vaccination (except for free according to regulations) and the cost of health examination.

(three) when the insured employee dies or is transferred from other places, the balance of his personal account can be withdrawn in cash, and the medical insurance relationship is terminated. If the insured workers go through the medical treatment procedures in different places, their personal accounts will be transferred to the financial accounts in cash every year.

What are the specific rules for outpatient service?

(a) the insured workers can apply for a specific outpatient service after continuous payment for 6 months (excluding 6 months), and enjoy specific outpatient treatment after approval. The maximum payment limit for specific outpatient expenses and hospitalization expenses of the employee medical insurance co-ordination fund in the year shall be calculated separately.

(two) the insured residents from the next month of payment, can apply for a specific outpatient service, and enjoy the treatment of a specific outpatient service after approval. The maximum payment limit of specific outpatient medical expenses and hospitalization medical expenses in the year of residents' medical insurance fund is calculated cumulatively. If the maximum payment limit of the residents' medical insurance fund in that year is exceeded, the residents' medical insurance fund will no longer pay the medical expenses in that year. And can only seek medical treatment in designated medical institutions within the administrative area of this Municipality.

(3) When the insured handles a specific outpatient service, the designated medical institution designated by the social security agency shall, after reviewing the relevant information, apply to the local social security agency for handling a specific outpatient service with the relevant certificate issued by the designated medical institution designated by the agency. The insured person enjoys different specific outpatient treatment according to the insurance mode and payment standard.

If the insured suffers from a specific disease that meets the requirements of outpatient service, he may apply for a specific outpatient service. The insured shall go through the formalities at the local social security agency with the Application Form for Specific Outpatient Service of Huizhou Social Basic Medical Insurance issued by the designated medical institution designated by the social security agency. Designated medical institutions designated by social security agencies to apply for specific outpatient services shall strictly implement the relevant provisions of the administrative department of labor security and social security agencies on specific outpatient services, and shall not issue relevant certification materials for insured persons who do not meet the prescribed conditions.

After the application for a specific outpatient service is approved, the insured person can go to the designated designated institution to see a doctor and buy medicine.

After the insured person converts the medical insurance coverage, the specific outpatient treatment will be implemented according to the new medical insurance coverage.

Medical expenses under the following circumstances shall not be paid by the medical insurance fund:

(a) to the city's non designated medical institutions (except emergency), retail pharmacies to buy drugs;

(2) Injuries caused by my illegal and criminal acts or accidental injuries caused by my intentional acts such as self-injury, fighting, alcoholism, motor vehicles, ships and aircraft in driving without a license, and other party responsibilities;

(three) medical expenses due to work-related injuries, maternity (excluding residents' medical insurance) and medical accidents;

(4) Medical expenses incurred due to cosmetic surgery or correction of congenital disability that is not needed for physiological functions;

(five) the cost of preventive health care and recuperation;

(six) medical expenses incurred during going abroad for business or personal reasons and going to Hongkong, Macao, Taiwan Province and other regions;

(seven) other expenses that may not be paid by the medical insurance fund in accordance with the relevant provisions of the state, province and city.

What are the rules for accidental injuries?

Accidental injury in any of the following circumstances, the medical insurance fund to pay:

(a) the responsibilities of the parties (excluding work-related injuries, suicides, self-mutilation, alcoholism, traffic accidents and their injuries and injuries caused by other illegal acts);

(two) after three months, the public security department can not determine the responsible person or the responsible person is unable to compensate;

Twenty-two, what are the designated hospitals with transfer qualifications within the administrative area of this Municipality?

Huizhou Central Hospital; Huizhou Hospital of Traditional Chinese Medicine; Huizhou Third People's Hospital (formerly Huizhou People's Hospital); Boluo County People's Hospital; Longmen County People's Hospital and Huidong County People's Hospital; Huiyang district people's hospital.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.