1. If it is commercial medical insurance, if the insured must have a ct examination during hospitalization, then the related medical expenses can generally be reimbursed by commercial medical insurance with self-funded medical expenses, and commercial medical insurance without self-funded medical expenses cannot be reimbursed. In addition, if the insured does not have the medical expenses of ct examination during hospitalization, for example, only one ct examination is needed during outpatient service, then medical insurance is generally not reimbursed. However, if he buys outpatient and emergency medical insurance and pays his own medical expenses, he can still reimburse the medical expenses generated by ct examination.
2. If it is basic medical insurance, ct medical expenses are not reimbursed, because ct medical expenses are self-funded medical expenses and are not within the scope of reimbursement of basic medical insurance. However, if there is money in the personal account of the basic medical insurance, you can still use the money in the personal account of the basic medical insurance to pay the ct medical expenses directly.
Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. The basic medical insurance fund consists of overall funds and individual accounts. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund.
The following items are not included in the scope of medical insurance reimbursement:
(1) service items.
(1) Registration fee, out-of-hospital consultation fee, medical record fee, etc.
(2) Special medical services, such as visiting fees, expedited fees for examination and treatment, additional fees for roll-call surgery, high-quality and low-price fees, and self-invited intensive care.
(2) Non-disease treatment projects.
(1) all kinds of beauty and bodybuilding, as well as non-functional plastic surgery and orthopedic surgery;
(2) various weight loss, weight gain and height increase projects;
(3) various health checks;
(4) all kinds of preventive health care and diagnosis projects;
(5) all kinds of medical consultation and medical appraisal.
(3) Diagnostic equipment and medical materials.
(1) Examination and treatment items of large medical equipment such as positron emission tomography (PET), electron beam cT and ophthalmic excimer laser therapeutic instrument;
(2) glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation devices;
(3) all kinds of self-use health care, massage, examination and treatment equipment;
(4) The provincial price department stipulates that one-time medical treatment cannot be charged separately.
(4) Treatment items.
(1) The organ source or tissue source of various organ or tissue transplants;
(2) Transplantation of organs or tissues other than kidneys, heart valves, corneal skin, blood vessels, bones and bone marrow;
(3) Orthopedic surgery for myopia;
(4) Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) others.
(1) various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
(2) all kinds of scientific research and clinical verification of diagnosis and treatment projects.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
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.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.