Rural Cooperative Medical Insurance
(1) Scope of reimbursement:
1. Medication expenses: auxiliary examinations: electrocardiogram, X-ray, film, The fee limit for various examinations such as laboratory tests, physical therapy, acupuncture, CT, MRI, etc. is 200 yuan; the operation fee (referring to national standards, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).
2. For elderly people over 60 years old who are hospitalized in Xingta Town Health Center, treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.
(2) Not included in the scope of reimbursement:
1. Seeking medical treatment on your own (without specifying a hospital or not applying for a referral), self-purchased drugs, and drugs that cannot be reimbursed under public medical regulations and medical expenses that are not in compliance with family planning;
2. Outpatient treatment expenses, house calls, hospitalization expenses, meals, companionship expenses, nutrition expenses, and blood transfusion expenses (except for those with family blood storage, according to relevant regulations reimbursement), heating and cooling fees, ambulance fees, special care fees and other expenses;
3. Medical expenses for car accidents, fights, suicide, alcoholism, work-related accidents and medical accidents;
4. Orthopedics, plastic surgery, dentures, prostheses, organ transplants, surgical fees, consultation fees, etc.;
5. Within the scope of reimbursement, the portion beyond the limit.
Employee medical insurance
The scope of medical treatment items for which basic medical insurance pays part of the cost
(1) Diagnostic and treatment equipment and medical materials
1. Apply X-ray computed tomography equipment (CT), stereotactic radiation equipment (γ-knife, χ-knife), cardiac and angiography X-ray machines (including digital subtraction equipment), and magnetic resonance imaging Examination and treatment projects for large-scale medical equipment such as MEI (MEI), SPECT (Single Photon Emission Electron Scanner), Color Doppler, and Medical Linear Accelerator;
2. Extracorporeal shock wave lithotripsy and Hyperbaric oxygen therapy;
3. Pacemakers, artificial joints, intraocular lenses, artificial organs for internal replacement of vascular stents, and materials placed in the body;
4. Provincial price department regulations of disposable medical materials that can be charged separately.
(2) Treatment items
1. Hemodialysis, peritoneal dialysis;
2. Kidneys, heart valves, cornea, skin, blood vessels, bones, Bone marrow transplantation;
3. Heart laser drilling, anti-tumor cell immunotherapy and fast neutron therapy projects.
4. Hearing aids and other rehabilitation equipment;
5. Various self-use health care, massage, examination, rehabilitation and treatment equipment.
(3) Treatment items
1. Organ sources or tissue sources for various organ transplants or tissue transplants;
2. Except for kidneys and heart valves , cornea, skin, blood vessels, bones, bone marrow transplants and other organ or tissue transplants;
3. Orthopedics for myopia;
4. Qigong therapy, music therapy, health care Nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(4) Others
1. Diagnosis and treatment items for various infertility (pregnancy) diseases and sexual dysfunction;
2. Various scientific research, Clinically verified diagnosis and treatment items;
1. Scope of diagnosis and treatment items that are not covered by basic insurance
(1) Service items
1. Registration fee , out-of-hospital consultation fees, medical record costs, etc.;
2. Consultation fees, expedited examination and treatment fees (except emergency), roll-call surgery surcharges, high-quality and low-price fees, self-recruitment special nurse fees and other special medical needs Serve.
(2) Non-disease treatment items
1. Various beauty (life beauty, medical beauty) and bodybuilding projects as well as non-functional plastic surgery, orthopedic surgery, etc.;
2. Various weight loss, fattening and heightening programs;
3. Various health examinations;
4. Various preventive and health-care diagnosis and treatment programs; registration Fees, out-of-hospital consultation fees, medical record costs, etc.;
5. Consultation fees, expedited examination and treatment fees (except emergency), roll-call surgery surcharges, high-quality and low-price fees, self-recruitment special nurse fees and other special needs Medical services.
(2) Non-disease treatment items
1. Various beauty (life beauty, medical beauty) and bodybuilding projects as well as non-functional plastic surgery, orthopedic surgery, etc.;
2. Various weight loss, fattening, and height-increasing programs;
3. Various health examinations;
4. Various preventive and health-care diagnosis and treatment programs;
5. Orthodontics, dental porcelain;
6. Various medical consultations (excluding psychiatric consultations) and medical appraisals.
(3) Diagnostic and treatment equipment and medical materials
1. Use large-scale medical equipment such as positron emission tomography scanning equipment, electron beam CT, ophthalmic excimer laser therapy equipment for examination and treatment Projects;
2. Rehabilitation equipment such as glasses, dentures, eyes, prostheses, and hearing aids;
3. Various self-use health care, massage, examination, rehabilitation and treatment equipment.
(4) Treatment Items
1. Organ sources or tissue sources for various organ transplants or tissue transplants;
2. Except for kidneys and heart valves , cornea, skin, blood vessels, bones, bone marrow transplants and other organ or tissue transplants;
3. Orthopedics for myopia;
4. Qigong therapy, music therapy, health care Nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1. Various diagnosis and treatment items for infertility (pregnancy) and sexual dysfunction;
2. Various scientific research, Clinically verified diagnosis and treatment items;
Urban Medical Insurance
The following expenses incurred by insured persons at designated medical institutions and designated retail pharmacies are included in the reimbursement scope of the Urban Resident Basic Medical Insurance Fund:
(1) Medical expenses for hospitalization;
(2) Medical expenses within 7 days before emergency stay for observation and transfer to hospitalization;
(3) ) Medical expenses that comply with the regulations on special diseases for urban residents;
(4) Other expenses that comply with the regulations.
Anything else not specified will not be included in the scope of reimbursement.
Legal basis:
Article 30 of the "Social Insurance Law of the People's Republic of China" The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(1) Should be paid from the work-related injury insurance fund;
(2) Should be borne by a third party;
(3) Should be paid by the public health department ;
(4) Seeking medical treatment abroad. Medical expenses shall be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party. Article 31 Social insurance agencies may sign service agreements with medical institutions and pharmaceutical business units to regulate medical service behavior based on the needs of management services. Medical institutions should provide reasonable and necessary medical services to insured persons.