Reimbursement.
I. Outpatient medical insurance reimbursement
Outpatient medical insurance coverage includes myasthenia gravis, polymyositis and dermatomyositis, systemic lupus erythematosus, psoriasis (pustular psoriasis, arthropathic psoriasis, erythrodermic psoriasis), ** proliferative dysplastic syndromes, true erythropoietic syndrome,
Leukodystrophy, aplastic anemia, hemophilia, chronic hepatitis B and its resulting compensated cirrhosis (antiviral therapy), chronic hepatitis C (antiviral therapy), antitumor drug therapy for malignant tumors.
Diagnosis of the basic medical insurance system established, outpatient registration fees, outpatient consultation fees, injection fees (including intramuscular injections, intravenous injections, subcutaneous infusion, intravenous infusion, pediatric scalp intravenous infusion) and the cost of pharmacy services merged into the general diagnostic and treatment fees, no longer separate pharmacy service fees, no longer the implementation of the merger of the original project fee standard. And these general medical fees, the future are available to the public health insurance fund to pay.
Warm tips for insured persons in the designated medical institutions outpatient clinic each prescription, acute diseases shall not exceed 3 days of the amount of ordinary chronic diseases shall not exceed 7 days of the amount of special chronic diseases and stable condition requires long-term use of the same type of drugs, shall not exceed 30 days of the amount. The basic medical expenses incurred in outpatient and emergency care are deducted from the individual account, and if the individual account is insufficient to cover the expenses, the insured person pays for them personally.
Two, employee health insurance outpatient reimbursement rate:
Active employees, to the hospital outpatient, emergency clinic after the visit, more than 2,000 yuan of medical expenses can be reimbursed, the reimbursement rate is 50%. In the case of retirees under the age of 70, expenses of $1,300 or more can be reimbursed, and the reimbursement rate is 70 percent.
If a retiree is over 70, expenses over $1,300 can be reimbursed the reimbursement rate is 80 percent. And no matter which category you are in, the maximum amount of expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, then 50 percent of the $500 portion can be reimbursed, which is $250.
Outpatient reimbursement rate for special diseases
Employee health insurance: within a health insurance year, the starting line for outpatient treatment of special diseases is 400 yuan, and the reimbursement rate for the medical expenses in line with the scope of treatment is the same as that of ordinary inpatient treatment.
Urban and rural residents' medical insurance: within a medical insurance year, the starting line for outpatient treatment of special diseases is 400 yuan, and the reimbursement rate of medical expenses in accordance with the scope of treatment is the same as that of general hospitalization.
Outpatient special diseases are currently 12 kinds of diseases
1, malignant tumors;
2, uremia outpatient renal dialysis;
3, tissue and organ transplantation outpatient treatment;
4, organ failure (heart, lung, liver, kidney); (5) cerebrovascular accidents during the recovery period;
5, hypertensive disease stage III (with heart, brain, kidney and eye complications) , brain, kidney, eye complications of one of the people;
6, diabetes mellitus (co-infection or heart, kidney, eye, neurological complications of one of the people);
7, chronic aplastic anemia;
8, systemic lupus erythematosus (with the heart, lung, liver, kidney and neurological complications of one of the people);
9, severe mental retardation disease;
10, hemophilia; (12) chronic hepatitis B (active hepatitis B), hepatitis B cirrhosis, chronic hepatitis C. (Data from a place in 17)
Extended information:
Employee health insurance reimbursement
I. Scope of diagnostic and treatment items for which the basic insurance does not cover the cost
(I) Service item category
1, registration fee, out-of-hospital consultation fee, and the cost of the medical record;
2, attendance fee, examination and treatment Expedited fee (except for emergency), surcharge for named surgery, quality premium fee, fee for self-employed special nurse and other special medical services.
(2) Non-disease treatment program category
1, a variety of cosmetic (life beauty, medical cosmetology) fitness program as well as messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, height projects;
3, a variety of health checkups;
4, a variety of preventive, health care clinic programs;
Medical insurance reimbursement
1, registration fee, out-of-hospital consultation fee, medical record cost, etc.;
2, consultation fee, examination and treatment expediting fee (except for emergencies), surcharge for named surgery, quality and premium fee, self-invited special nurse fee, and other special medical services.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical aesthetics) fitness program and messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase in height projects;
3, a variety of health checkups;
4, a variety of preventive, health care treatment programs;
5, dental orthodontics, dental porcelain;
6, a variety of medical consultations (excluding psychiatric consultations), medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the examination and treatment of the project;
2, eyeglasses, dental prostheses, prosthetic eyes, prosthetic limbs, hearing aids, and other rehabilitation appliances;
3, all kinds of health care for their own use, massage, examination, rehabilitation and therapeutic instruments.
(4) therapeutic items category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation other organs or tissue transplantation;
3, myopic eye orthopaedics;
4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other complementary treatment therapy, magnetic therapy and other complementary treatment programs.
(5) Other
1, various infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, various scientific research, clinical verification of diagnosis and treatment programs;
2, basic medical insurance to pay part of the cost of the diagnosis and treatment program range
(1) Diagnostic and treatment equipment and medical materials
1, the application of X-ray computed tomography devices, and the use of medical materials. -ray computed tomography (CT), stereotactic radiography (γ-knife, χ-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single-photon emission computerized scanning device (SPECT), Color Doppler, medical linear gas pedal and other large medical equipment for examination, treatment projects;
2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3, pacemakers, artificial joints, artificial crystals, vascular scaffolds in vivo replacement of artificial organs, in vivo replacement of materials;
4, the provincial price department can be charged separately for the disposable medical materials. .
(B) treatment project category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Hearing aids and other rehabilitation appliances;
3, a variety of self-use health care, massage, check rehabilitation and treatment equipment.
(3) therapeutic items category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation;
3, myopic eye orthopaedic surgery;
4, qigong therapy, music therapy, health care of the nutritional therapy, magnetic therapy and other complementary treatment programs.
(4) Other
1, all kinds of infertility (pregnancy), sexual dysfunction diagnosis and treatment program;
2, all kinds of scientific research, clinical validation of diagnosis and treatment program;
Baidu Encyclopedia-Medicare Reimbursement Scope