Outpatient care is generally not reimbursable, the classification of health insurance reimbursement as well as the items included are as follows:
1, general medical insurance mainly includes outpatient costs, medicine, examination costs;
2, hospitalization insurance is mainly the cost of hospitalization per day, the use of hospital equipment, surgical costs, medicine;
3, surgical insurance to provide for all the costs incurred due to the patient needing to undergo a necessary surgery;
4. Comprehensive medical insurance, the cost of which covers all the costs of medical treatment and hospitalization and surgery, etc.
5. Special disease insurance, certain special diseases often bring to the patient is a catastrophic payment of the cost of the general residents of the family can hardly afford.
For example, cancer and heart disease. Provide coverage for policyholders of major diseases, can be a single, such as malignant tumors, or even malignant tumors in a certain number of cancers.
Legal basis
The Social Insurance Law of the People's Republic of China*** and the State of China
Article 23 Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employing unit and the employees in accordance with the state regulations*** together.
Individual industrial and commercial households without employees, part-time employees who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations. Article 27 Individuals who have participated in the basic medical insurance for employees, and whose accumulated contributions have reached the number of years stipulated by the state when they reach the legal retirement age, shall no longer pay the basic medical insurance premiums after their retirement, and shall enjoy the basic medical insurance benefits in accordance with the state regulations; those who have not yet reached the number of years stipulated by the state may pay the contributions up to the number of years stipulated by the state. Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the workers' compensation insurance fund;
(2) those that should be borne by a third person;
(3) those that should be borne by public **** health;
(4) those that are sought outside the country.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.