Reimbursement.
1. Outpatient medical insurance reimbursement scope
The coverage of outpatient medical insurance includes myasthenia gravis, polymyositis and dermatomyositis, systemic lupus erythematosus, and psoriasis ( Pustular psoriasis, arthropathic psoriasis, erythrodermic psoriasis), **dysplastic syndrome, polycythemia vera,
Beh?et's disease, aplastic Anemia, hemophilia, chronic hepatitis B and its caused compensated cirrhosis (antiviral treatment), chronic hepatitis C (antiviral treatment), and anti-tumor drug treatment of malignant tumors.
After the basic medical insurance system is established, outpatient registration fees, outpatient examination fees, injection fees (including intramuscular injection, intravenous injection, subcutaneous infusion, intravenous infusion, pediatric scalp intravenous infusion) and pharmaceutical service costs It will be merged into general diagnosis and treatment fees, and pharmaceutical service fees will no longer be set up separately, and the charging standards for the original merged items will no longer be implemented. These general diagnosis and treatment fees can be paid from the public's medical insurance funds in the future.
Warm reminder that the amount of medicine prescribed for each insured person when visiting the outpatient clinic of a designated medical institution should not exceed 3 days for acute diseases, and 7 days for ordinary chronic diseases. Those with special chronic diseases and whose condition is stable need to take it for a long time. For the same type of drugs, the dosage shall not exceed 30 days. Basic medical expenses incurred in outpatient and emergency services will be deducted from the personal account. If the personal account is insufficient for payment, the insured person shall pay it out of pocket.
2. Outpatient reimbursement ratio of employee medical insurance:
Only for active employees who go to the hospital’s outpatient clinic or emergency department for medical treatment, medical expenses exceeding 2,000 yuan can be reimbursed, and the reimbursement ratio is 50%. For retirees under the age of 70, expenses exceeding 1,300 yuan can be reimbursed at a reimbursement rate of 70%.
For retirees over 70 years old, the reimbursement ratio for expenses exceeding 1,300 yuan is 80%. Regardless of the type of person, the maximum amount of large medical expenses paid for outpatient and emergency services is 20,000 yuan. For example, if you are an active employee and the cost of outpatient treatment is 2,500 yuan, then 50 yuan of the 500 yuan part can be reimbursed, which is 250 yuan.
Outpatient reimbursement ratio for special diseases
Employee medical insurance: within one medical insurance year, the minimum payment line for special disease outpatient services is 400 yuan, and the reimbursement ratio of medical expenses that meets the prescribed treatment range is the same as ordinary hospitalization treatment same.
Urban and Rural Residents Medical Insurance: Within a medical insurance year, the minimum outpatient payment for special diseases is 400 yuan, and the reimbursement ratio of medical expenses that meet the prescribed treatment range is the same as that of ordinary hospitalization.
There are currently 12 types of special diseases in the outpatient clinic
1. Malignant tumors;
2. Uremia outpatient renal dialysis;
3. Outpatient treatment after tissue and organ transplantation;
4. Organ failure (heart, lung, liver, kidney); (5) Cerebrovascular accident recovery period;
5. Stage three hypertension (those with one of heart, brain, kidney, or eye complications);
6. Diabetes (those with infection or one of heart, kidney, eye, or nervous system complications);
7. Chronic aplastic anemia;
8. Systemic lupus erythematosus (with any of the heart, lung, liver, kidney and nervous system complications);
9. Severe mental disorders;
10. Hemophilia; (12) Chronic hepatitis B (active hepatitis B), hepatitis B cirrhosis, and chronic hepatitis C. (Data from a certain place in 2017)
Extended information:
Employee medical insurance reimbursement
1. Scope of diagnostic and treatment items that are not covered by basic insurance
(1) Service items
1. Registration fee, out-of-hospital consultation fee, medical record cost, etc.;
2. Clinic fee, expedited examination and treatment fee (except for emergency cases) ), roll-call surgery surcharge, high-quality and low-price fee, self-recruitment of special nurse fee and other special medical services.
(2) Non-disease treatment items
1. Various beauty (life beauty, medical beauty) and bodybuilding projects as well as non-functional plastic surgery, orthopedic surgery, etc.;
2. Various weight loss, fattening, and height-increasing programs;
3. Various health examinations;
4. Various preventive and health-care diagnosis and treatment programs;
Medical insurance reimbursement
1. Registration fee, out-of-hospital consultation fee, medical record cost, etc.;
2. Clinic fee, expedited examination and treatment fee (except emergency) , roll-call surgery surcharge, high-quality and low-price fee, self-recruitment of special nurse fee and other special medical services.
(2) Non-disease treatment items
1. Various beauty (life beauty, medical beauty) and bodybuilding projects as well as non-functional plastic surgery, orthopedic surgery, etc.;
2. Various weight loss, fattening, and height-increasing programs;
3. Various health examinations;
4. Various preventive and health-care diagnosis and treatment programs;
5. Orthodontics, dental porcelain;
6. Various medical consultations (excluding psychiatric consultations) and medical appraisals.
(3) Diagnostic and treatment equipment and medical materials
1. Use large-scale medical equipment such as positron emission tomography scanning equipment, electron beam CT, ophthalmic excimer laser therapy equipment for examination and treatment Projects;
2. Rehabilitation equipment such as glasses, dentures, eyes, prostheses, and hearing aids;
3. Various self-use health care, massage, examination, rehabilitation and treatment equipment.
(4) Treatment Items
1. Organ sources or tissue sources for various organ transplants or tissue transplants;
2. Except for kidneys and heart valves , cornea, skin, blood vessels, bones, bone marrow transplants and other organ or tissue transplants;
3. Orthopedics for myopia;
4. Qigong therapy, music therapy, health care Nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1. Various diagnosis and treatment items for infertility (pregnancy) and sexual dysfunction;
2. Various scientific research, Clinically verified diagnosis and treatment items;
2. Scope of diagnosis and treatment items for which basic medical insurance pays part of the cost
(1) Diagnostic and treatment equipment and medical materials
1 , applied X-ray computed tomography device (CT), stereotactic radiation device (γ-knife, χ-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (MEI), single photon emission electron scanning equipment (SPECT), color Doppler, medical linear accelerator and other large medical equipment for examination and treatment projects;
2. Extracorporeal shock wave lithotripsy and high pressure Oxygen therapy;
3. Pacemakers, artificial joints, intraocular lenses, artificial organs for internal replacement of vascular stents, and materials placed inside the body;
4. Regulations prescribed by the provincial price department Disposable medical materials available for separate charge.
(2) Treatment items
1. Hemodialysis, peritoneal dialysis;
2. Kidneys, heart valves, cornea, skin, blood vessels, bones, Bone marrow transplantation;
3. Heart laser drilling, anti-tumor cell immunotherapy and fast neutron therapy projects.
Hearing aids and other rehabilitation equipment;
3. Various self-use health care, massage, examination, rehabilitation and treatment equipment.
(3) Treatment items
1. Organ sources or tissue sources for various organ transplants or tissue transplants;
2. Except for kidneys and heart valves , cornea, skin, blood vessels, bones, bone marrow transplants and other organ or tissue transplants;
3. Orthopedics for myopia;
4. Qigong therapy, music therapy, health care Nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(4) Others
1. Diagnosis and treatment items for various infertility (pregnancy) diseases and sexual dysfunction;
2. Various scientific research, Clinically verified diagnosis and treatment items;
Baidu Encyclopedia - Medical insurance reimbursement scope