Publicly funded medical care refers to a social security system implemented by the state for the protection of state workers, through the medical and health sector to provide free medical and preventive services to the enjoyment of the person in accordance with the provisions of a social security system. Here is my compilation of 2017 public medical reimbursement related issues, welcome to read!
Publicly-funded medical reimbursement range
Publicly-funded medical care refers to a social security system that is implemented by the state to protect state workers and provide free medical and preventive services to the enjoyment of the personnel through the medical and health sector according to regulations. So, what is the scope of reimbursement for public medical expenses? Below I take Beijing and Guangzhou as an example, for your brief introduction, just for reference!
1, Guangzhou public medical reimbursement range
Guangzhou city public medical reimbursement of sporadic reimbursement of the scope of the following:
To carry out a number of particularly expensive 'checkups and treatment programs, such as the installation of artificial organs, organ transplants, cardiac valve replacement, coronary artery angioplasty, stent implantation, cardiac ablation, interventional embolism chemotherapy and medical expenses incurred for examinations and treatments such as various types of imaging.
Medical expenses incurred for CT, MRI, ECT, color Doppler, 24-hour dynamic electrocardiogram and extracorporeal lithotripsy for family members, the cost of which is more than RMB 300 yuan per item.
Medical expenses incurred during family visits by retired cadres during emergency treatment in other places with the approval and consent of the municipal public medical management department.
2. The scope of reimbursement for Beijing's publicly-funded medical treatment
According to the "Measures for the Administration of Beijing's Publicly-Funded Medical Treatment", the scope of reimbursement for Beijing's publicly-funded medical treatment is as follows:
1. Medical expenses incurred in designated medical units (including bed charges, examination fees, medicine fees, treatment fees, surgical fees and so on) when holding a certificate of treatment issued by the competent authorities of the public-funded medical treatment department of this city.
The medical fees for medical treatment at the nearest medical institution (national or collective) due to an emergency that prevents the patient from going to the designated medical institution (emergency treatment only). Reimbursement of medical expenses must be accompanied by a certificate of emergency diagnosis and prescription of medicines.
Third, in accordance with the principle of hierarchical division of labor and medical treatment, medical fees for medical treatment at a higher level of medical care by referral from a designated medical unit.
Fourth, retirees and pensioners with the "nearest medical card" to the designated medical unit for medical expenses.
V. Medical expenses incurred when a person is temporarily ill while away from home on official business or visiting relatives on vacation, and is treated at the nearest local medical unit (national or collective), or when the person's condition requires that he/she obtains a referral certificate and is referred to another medical unit for medical treatment. When reimbursing the medical expenses, it is necessary to attach the diagnostic certificate and drug prescription.
VI. During the recovery period after hospitalization for surgery or treatment of critical illnesses, short-term convalescence or rehabilitation is required, and the medical expenses are approved by the competent authorities of the public medical service upon the recommendation of the original treatment unit and the completion of the summary of the condition and the consent of the unit where the medical expenses are incurred.
Seven, because the original treatment unit does not have the drugs must be purchased (refers to the state medical stores or other medical units) and accompanied by the hospital authorities in charge of the examination and approval of the outsourcing certificate and prescription of the cost of medicines.
VIII. The cost of medicines that are transferred to an overseas medical unit for treatment in accordance with the regulations and with the approval of the competent department for publicly-funded medical treatment.
9. Medical expenses for family planning surgery.
X. General medicine fees for medical treatment in the health section (office) of the unit's infirmary and health center.
Ten
I. Medical expenses for injuries and disabilities incurred in the line of duty.
Ten
2. Expenses for precious and tonic medicines (including blood products) necessary for the resuscitation of critically ill patients (on the basis of the certificate of resuscitation from the medical unit) or for the treatment of official injuries (on the basis of the certificate from the unit).
The following items are partially reimbursed:
I. Imported artificial organs installed on the basis of certificates issued by the treating units due to the needs of medical conditions. For example, the cost of installing pacemakers, heart valves, artificial larynx and artificial hip joints can be reimbursed in accordance with the maximum price of similar types of artificial organs in China.
Installation of imported artificial organs not yet produced domestically can be reimbursed with reference to the reimbursement rate for installation of pacemakers.
Two, because of the condition of the need for organ transplants, in the course of surgical treatment of the medical expenses required, the public medical expenses reimbursement of eighty percent. The other twenty percent shall be borne by the enjoying unit and the individual. Which the proportion of the individual's burden does not exceed five percent of twenty percent (divorced, retired, in the township of the second class B above the revolutionary disabled soldiers and college students do not bear the burden of their own).
Three, approved convalescence or rehabilitation medical treatment (refers to non-surgical or non-critical illness hospitalization after the recovery period of the personnel) required for medical expenses, public medical expenses only reimbursement of the cost of medicines.
4. Ninety-five percent of the cost of examinations (x-ray and radiological examinations other than laboratory tests) and hospitalization fees incurred at China-Japan Friendship Hospital shall be reimbursed by the public medical fund. The other five percent will be borne by the patient.
Tips: 2010 public medical reform will be fully implemented. The civil servants of the organs and institutions belonging to the districts and counties of Beijing will all be included in the basic medical insurance within this year. 2012 New Year's Day, Beijing 220,000 municipal public medical personnel were formally included in the medical insurance.
Legal basis: The People's Republic of China **** and the State Social Insurance Law, Article 26 of the basic medical insurance for employees, the new rural cooperative medical care and the basic medical insurance for urban residents in accordance with the national provisions of the standard of treatment.