1. Services: registration fee, out-of-hospital consultation fee, medical record cost, etc.; visit fee, examination and treatment expediting fee, surcharge for named surgery, surcharge for named surgery, quality and premium fee, self-invited special nurses and other special medical services;
2. Non-disease treatment items: all kinds of cosmetic, fitness programs and non-functional Plastic surgery, orthopedic surgery, etc.; a variety of weight loss, weight gain, height projects; a variety of health body reimbursement; a variety of preventive, health care diagnostic and therapeutic programs; a variety of medical consulting, medical appraisal;
3, diagnostic and therapeutic equipment and medically useful materials: application of Positron Emission Tomography (PET) scanning device (PET), electron-beam CT, ophthalmology, excimer laser therapy and other large-scale medical equipment, inspection, treatment programs
4, therapeutic projects: all kinds of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues; myopic orthopedics; qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects;
5, is the other categories: all kinds of infertility (pregnancy) disease, Sexual dysfunction diagnostic and treatment programs; various scientific research, clinical verification of the diagnostic and treatment programs.
1. Individual out-of-pocket expenses (the "all out-of-pocket" item in the medical bill) refers to the cost of medicines and medical items that do not belong to the scope of the medical insurance catalog and are paid in full by the individual, and are not counted as part of the annual accumulation of medical expenses. The items that are not reimbursed by the medical insurance are mainly those that are not clinically necessary, those with uncertain effects, and those for special medical services.
2. Individual out-of-pocket expenses (the "out-of-pocket 2" item in the medical bill) refers to the expenses that are covered by the medical insurance fund but should be paid by the individual in a certain percentage. For example, Class B drugs are not counted as part of the total annual medical expenses. Class A drugs are drugs that are uniformly formulated by the State and are widely used in clinical practice, and are paid for in accordance with the provisions of the basic medical insurance scheme. Class B drugs refer to those drugs for which the basic medical insurance fund has the ability to partially pay for the costs. Costs incurred by the use of such drugs are first paid for by the employee as a certain percentage of the costs out of pocket, and then included in the scope of the basic medical insurance fund's benefits and paid for in accordance with the provisions of the basic medical insurance scheme. Category A drugs are fully reimbursed , Category B drugs are reimbursed 70-80%, and individuals pay a 20-30% rate.
3. Individual out-of-pocket expenses (the "out-of-pocket" item in the medical bill) refer to the outpatient out-of-pocket section and the expenses paid by the individual within the starting standard for inpatient hospitalization, which are counted in the annual accumulation of medical expenses.
(1) Outpatient deductible section
(2) Hospitalization starting standard: Within a medical insurance year, the individual will be responsible for the accumulated hospitalization medical expenses below the starting standard, and will be reimbursed proportionally if the expenses are above the starting standard.
4. Individual's share (the "out-of-pocket" item in the medical bill) refers to the part of the expenses exceeding the outpatient out-of-pocket section or the hospitalization starting standard that is paid by the individual on a pro-rata basis, and is counted as part of the yearly accumulation of medical expenses. (1) Outpatient Individual Proportion: After the annual outpatient out-of-pocket accumulation exceeds the stipulated amount, it enters into the *** negative section, and the medical expenses are shared by the coordinated fund and the individual in different proportions according to the type of hospital.
(2) Individual share of hospitalization: the medical expenses incurred by the insured person for hospitalization within the year of medical insurance shall be shared by the medical insurance fund and the individual in different proportions according to the part of the medical expenses above the starting payment standard.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China conforms to the standards of the basic medical insurance drug directory, diagnostic and therapeutic items, medical services and facilities, as well as the medical expenses of the emergency and rescue, which shall be paid out of the basic medical insurance fund in accordance with the state regulations.