Observation in the emergency observation room showed the following symptoms: acute severe trauma, brain trauma, fracture, dislocation, laceration, burn, sudden acute abdominal pain, sudden high fever, sudden bleeding, vomiting blood, signs of internal bleeding, diarrhea, severe dehydration, shock, convulsion or coma, ear, nose, throat, eye, trachea, bronchus, esophagus and intraocular foreign bodies. Sudden onset, severe symptoms, rapid deterioration after onset, suspected poisoning, drowning, electric shock, acute urinary incontinence, acute allergic diseases, serious infectious diseases, and other attending doctors think that life is in danger and should be urgently rescued.
Inspection items that can be reimbursed:
1. Stereotactic radiation device using X-ray computed tomography device [γ knife, χ knife];
2. Cardiac angiography machine [including digital subtraction equipment];
3. Magnetic resonance imaging equipment;
4. Single photon emission computer scanning device;
5, color Doppler, medical linear accelerator and other large medical equipment inspection medical items and single cost more than 200 yuan/Taiwan inspection medical items.
Treatment items that can be reimbursed:
1, extracorporeal shock wave lithotripsy, hyperbaric oxygen therapy, medical linear accelerator therapy, intensive care and rescue in CCU and ICU wards;
2. Kidney transplantation, heart valve transplantation, corneal transplantation, skin transplantation, blood vessel transplantation, bone transplantation, bone marrow transplantation and islet transplantation;
3. Replacement and installation of pacemaker, artificial joint, intraocular lens, artificial larynx, artificial hip joint and other artificial organs, heart bypass surgery and balloon dilatation of cardiac catheter;
4. Hemodialysis and peritoneal dialysis;
5. Cardiac laser drilling, anti-tumor cellular immunotherapy, interventional therapy and fast neutron therapy projects.
6, a single cost more than 200 yuan/treatment projects.
Policy provisions on reimbursement of medical expenses incurred by insured employees in business trips, family visits and long-term residence in different places:
1. The medical expenses incurred by the insured employees on business trips or visiting relatives in other places will only be reimbursed for emergency expenses in other places that meet the requirements of medical insurance, and all expenses incurred for hospitalization for non-emergency reasons will not be reimbursed.
2, the insured workers living in the field for more than 6 months, according to the nature of long-term living in the field of medical expenses.
3, long-term residents should provide proof by the unit, determine the secondary designated hospitals (should be designated medical institutions for local medical insurance), and timely handle the "Zhenjiang long-term residents medical expenses reimbursement card".
4. Employees who live in other places for a long time must adhere to the principle of economy and prescribe drugs in a limited amount according to regulations (the acute dosage is within 3 days, the chronic dosage is within 10 days, and the dosage of tuberculosis, hypertension and diabetes can be extended to 30 days). Those who exceed the above standards will not be reimbursed for medicine.
5, long-term residence in the field of referral, need to be signed by the local designated hospitals, step by step according to the principle of territoriality referral, referral hospital for medical insurance for employees in our city to determine the special hospital. The individual pays 65438+ 00% of the total expenses first, and then reimburses the expenses according to the medical insurance regulations. Other hospitals and individuals pay 20% of the total expenses first, and then reimburse medical expenses according to medical insurance regulations.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.