What parts of hospitalization expenses are reimbursed

Generally speaking, with a medical-related insurance policy, the expenses that can be reimbursed when an insured person is hospitalized include daily hospital fees, the cost of using hospital equipment, surgical costs, and medical expenses incurred during the hospitalization. The expenses and percentage that can be reimbursed will vary from one insurance policy to another.

I. Scope of medical treatment items for which basic insurance does not cover expenses

(1) Service item category

1, registration fee, out-of-hospital consultation fee, and cost of medical records;

2, consultation fee, expedited fee for checkups and treatments (except for emergencies), surcharge on named surgeries, high quality and premium fee, and fee for self-invited special nurses, and other specially needed medical services.

(2) Non-disease treatment programs

1, various cosmetic (cosmetic life, medical cosmetology) fitness programs as well as messy non-functional plastic surgery, orthopedic surgery, etc.

2, various weight loss, weight gain, height increase programs;

3, various health checkups;

4, a variety of preventive, health care treatment programs; registration fees, consultation fees, medical records of workers' book fees. Consultation fee, medical record cost, etc.

5. Special medical services such as consultation fee, expedited examination and treatment fee (except for emergency), surcharge for named surgery, high quality and premium fee, and fee for hiring special nurses by oneself.

(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, weight gain, 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 category

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 program;

2, eyeglasses, dental prostheses, prosthetic eyes, prosthetic limbs, hearing aids, and other rehabilitation appliances;

3, all kinds of self-use health care, Massage, examination and rehabilitation and treatment instruments.

(4) therapeutic items category

1, all kinds of organ transplantation or tissue transplantation of organ or tissue source;

2, in addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues;

3, myopic orthopaedic surgery;

4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other complementary therapeutic therapy, magnetic therapy and other complementary treatment programs.

(5) Others

1, various infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;

2, various scientific research, clinical verification of diagnosis and treatment programs; urban health insurance participants in designated medical institutions, designated retail pharmacies, the following items are included in the reimbursement of urban residents' basic health insurance fund:

(1) (a) medical expenses for hospitalization;

(b) medical expenses incurred within 7 days before being transferred to inpatient treatment in case of emergency;

(c) medical expenses in accordance with the regulations on special outpatient diseases for urban residents;

(d) other expenses in accordance with the regulations. The rest are not included in the scope of reimbursement.

Legal Basis

The Social Insurance Law of the People's Republic of China

Article 30

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the Workers' Compensation Insurance Fund;

(2) those that should be borne by a third party;

(3) those that should be paid by a third person;

(4) other expenses that are not stipulated in the rules. person;

(iii) should be borne by the public ****health;

(iv) medical treatment outside the country.

Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after making the payment first.

Article 28

Medical expenses in accordance with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with national regulations.