If the examination fees incurred during hospitalization are reimbursable, if the costs incurred on an outpatient basis are not reimbursable. This is because the commercial insurance coverage must be hospitalized expenses. If you are subsequently hospitalized, you can be partially reimbursed for the outpatient visit prior to the hospitalization.
Auxiliary examination center EEG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement of 1,000 yuan). 60 years old and above hospitalized in the Xingta Town Health Center, the treatment fee and nursing care costs are compensated for 10 yuan per day, a limit of 200 yuan.
The general procedure for reimbursement is as follows: holding a health insurance handbook and IC card - > hospital health insurance office registration - > auditing and verification of the card - payment of hospitalization deposit - > hospitalization - for out-of-pocket items need to be agreed upon by the patient and signed - > cash or IC card settlement of the starting standard and out-of-pocket ratio of the out-of-pocket portion of the payment - > co-ordination of the scope of the hospital first advances - > settlement of discharge. gt; Settlement of discharge.
Expanded Information:
The following items are not reimbursed by Medicare:
(a) Service item category.
(1) registration fee, out-of-hospital consultation fee, medical record cost, etc.;
(2) special medical services such as consultation fee, expedited fee for examination and treatment, surcharge for named surgery, quality premium fee, and self-invited special nurses, etc.
(3) special medical services such as medical care, medical treatment, and medical care, etc.,
(4) special medical services such as medical care, medical care, and medical care.
(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 health checkups;
(4) a variety of preventive, health care diagnosis and 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.
Medical insurance reimbursement rate:
1. Outpatient and emergency medical expenses: the part of medical expenses exceeding 2,000 yuan in total within the annual period (January 1~December 31) of an active employee that is covered by the basic medical insurance.
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 reimbursement of medical expenses.
4, three kinds of special disease outpatient medical treatment: participants suffering from malignant tumors radiation therapy and chemotherapy, kidney dialysis, kidney transplantation to take anti-rejection drugs need to be in outpatient medical treatment, by the participant's second and third-class designated hospitals for medical treatment issued 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. The 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.
Baidu Encyclopedia - Reimbursement Scope of Medical Insurance