Retirees hospitalized medical insurance starting standard above to 5,000 yuan part of the payment at 85%; more than 5,000 yuan to 10,000 yuan part of the payment at 90%.
Medical insurance reimbursement ratio:
1. Outpatient and emergency medical expenses: the part of the medical expenses that meet the scope of the basic medical insurance within the annual period (January 1~December 31) of the active employees that are more than 2,000 yuan in total.
2. Settlement ratio: 50% reimbursement for the part of over 2,000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff is 20,000 yuan cumulatively in a year.
3. The insured personnel should keep the outpatient medical bills (including receipts and prescription bottoms for the parts below the large amount) of the outpatient treatment in the designated hospitals as the vouchers for the reimbursement of medical expenses.
4, three kinds of special disease outpatient medical care: participants suffering from malignant tumors radiation therapy and chemotherapy, kidney dialysis, kidney transplantation to take anti-rejection drugs need to be in outpatient medical care, by the participant's second and third-class designated hospitals for medical care to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the regional medical insurance center for approval and filing. The form will be submitted to the district medical insurance center for approval and filing. Outpatient medical treatment and medicine collection for these three special diseases are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.
The following items are excluded from the reimbursement of medical insurance:
(i) Service item category.
(1) registration fee, out-of-hospital consultation fee, and cost of medical records;
(2) special medical services such as consultation fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, and self-invited special nurse.
(2) The category of non-disease treatment programs.
(1) a variety of beauty, fitness and non-functional cosmetic, orthopedic surgery;
(2) a variety of weight loss, weight gain, height projects;
(3) a variety of physical examination;
(4) a variety of preventive, health-care treatment programs;
(5) a variety of medical consultation, medical appraisal.
(3) diagnostic and treatment equipment and medical materials.
(1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapeutic instrument and other large-scale medical equipment for the examination and treatment program;
(2) glasses, denture, eye prosthesis, prosthetic, prosthetics, hearing aids and other rehabilitative appliances;
(3) all kinds of self-use of health care, massage, checking and treatment equipment;
(4) the provincial price department regulations can not be charged separately for disposable medical use.
(4) treatment program category.
(1) all kinds of organ or tissue transplantation of organ source or tissue source;
(2) in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation;
(3) myopic orthopedic surgery;
(4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.
(5) Others.
(1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program;
(2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
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