At present, robotic surgery has not been entered into the medical insurance catalog, the start-up cost of robotic surgery and the cost of the robotic arm, at present, the medical insurance still can not be reimbursed, but the cost of the surgery itself can be reimbursed.
Reimbursement scope:
1, medical insurance coverage of hospitalization medical expenses insurance responsibility
Basic medical insurance, major medical insurance, medical assistance and other reimbursement is still borne by the individual part of the cost of medical insurance directory, in the scope of the agreed insurance responsibility for the responsibility to pay. 1 million coverage, 15,000 yuan deductible, the reimbursement rate of 80%, continuous participation in reimbursement rate of up to 85%;
The reimbursement rate is also increased to 85%, and the reimbursement rate is also increased to 85%. The insurance liability for hospitalization medical expenses outside the scope of medical insurance
2. The insurance liability for hospitalization medical expenses outside the scope of medical insurance
After reimbursement through the basic medical insurance, major disease insurance, medical aid and other reimbursement, the part of the expenses outside the medical insurance directory that are still borne by the individual will bear the responsibility of payment within the scope of the insurance liability agreed upon. 1,000,000 coverage, 18,000 yuan deductible, the reimbursement rate of 60%, and the reimbursement rate of continuous participation in the insurance will be adjusted to 65%. 65%;
3, outpatient specific high drug cost insurance liability
In the designated hospitals, designated pharmacies expenditure of drug costs, the part of the cost borne by the individual, in the agreed scope of the insurance responsibility to assume the responsibility to pay. 700,000 coverage, 26 kinds of drugs, with the designated rare disease outpatient drug/inpatient medical insurance cost insurance liability*** with a deductible of 20,000 yuan, the proportion of benefits 80%;
4. Specified Rare Disease Outpatient Drugs/Inpatient Medical Insurance Expense Insurance Liability
The part of the drug expenses incurred in designated hospitals and designated pharmacies that are borne by individuals will bear the responsibility of payment within the scope of the agreed insurance liability. 300,000 insured amount, 12 kinds of medicines, with the insurance liability of outpatient specified high-value drug expense*** with a deductible of 20,000 yuan, reimbursement percentage 70%.
In summary, the close convergence of basic medical insurance (including urban workers' basic medical insurance, urban and rural residents' basic medical insurance), universal price and other characteristics. It focuses on the protection of high medical expenses caused by major diseases and accidents, and provides more adequate protection for major diseases. Compared with general commercial insurance, there is no restriction on the age and occupation of the insured, and the health requirements are more lenient. Meanwhile, it expands the cost of treatment for 20 high-cost specific drugs outside the medical insurance catalog and 10 designated rare disease drugs.
Legal basis:
Article 2 of the Insurance Law of the People's Republic of China*** and the State of China
Insurance, as referred to in this law, refers to the insurance policyholder, according to the contract, pays the premiums to the insurer, and the insurer bears the responsibility of compensating the insurance premiums for the property losses caused by the contractually agreed upon accidents that may occur due to the occurrence of the accident or when the insured person's death, disability, disease, or reaching the age, duration and other conditions agreed in the contract. The commercial insurance behavior of the insured's death, disability, illness, or when the insured person reaches the age and period agreed in the contract to assume the responsibility of paying the insurance premiums.
Article 3
This Law shall apply to insurance activities within the territory of the People's Republic of China*** and the State.
Article 5
Parties to insurance activities shall exercise their rights and fulfill their obligations in accordance with the principle of honesty and credit.