A, medical insurance reimbursement scope covers which
According to the provisions of the basic medical insurance does not pay the cost of diagnosis and treatment items **** five categories. The first category is the class of service items: part of the medical service fee, out-of-hospital consultation fees, medical records cost, etc.; visit fees, examination and treatment of expedited fees, naming surgery surcharge, naming surgery surcharge, quality premium fee, self-requested special nurses and other special medical services. The second category is the non-disease treatment program category: see the following analysis. The third category is the diagnostic and therapeutic equipment and medically useful materials: the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser treatment device and other large-scale medical equipment for the examination and treatment program. Eyeglasses, denture, eye prosthesis, prosthetic limbs, hearing aids and other rehabilitative devices. All kinds of self-use health care, massage, examination and treatment equipment. Provincial price departments do not charge a separate disposable medical materials. The fourth category is the treatment project category: all types of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation, other organs or tissue transplantation; myopic orthopedics; qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects. The fifth category is other categories: various scientific research, clinical verification of the diagnosis and treatment programs. In addition, the basic medical insurance does not pay the cost of transportation, emergency vehicle fees; baby incubator fees, food incubator fees, nursing fees, cleaning fees, outpatient decoction fees; meals and other special needs living services. Patient medical expenses incurred in the above items to be paid out of pocket. The non-disease treatment programs include these: 1, a variety of cosmetic, plastic surgery programs: such as acne, scar cosmetic, laser cosmetic, cosmetic cleaning, hair transplantation, etc. 2, orthopedic treatment. 2, orthopedic treatment programs: stuttering, dental irregularities, denture repair (including stump crowns, sets of crowns, installation of denture), dental implants, snoring surgery (except respiratory distress), flat feet and other projects (congenital cervical slope, cleft lip and palate, except for the sequelae of poliomyelitis). 3, a variety of bodybuilding treatment programs: such as weight loss, fat, height and so on. 4, a variety of health checkup programs: such as employee physical examination, disease screening. 5, a variety of preventive, health care treatment programs: such as a variety of vaccination, fitness massage. 6, a variety of medical consultations, health forecasting and treatment programs: such as a variety of disease consultation fees (second and third-level mental health prevention and treatment institutions to carry out psychological counseling, except), finger pulse instrument, microcirculation checker, meridian diagnostic instrument (including traditional Chinese medicine computerized diagnostic instrument), the life of the information diagnostic and treatment instrument. 7, a variety of medical appraisal projects: such as labor appraisal (employee labor, industrial injuries, occupational disease diagnosis and appraisal), the judicial appraisal of mental patients, medical accidents appraisal, a variety of inspection fees, etc..Two, medical reimbursement time limit
Medical reimbursement time limit. (A) hospitalization and outpatient treatment of special diseases settlement procedures fixed-point medical institutions in the 10th of each month, the last month discharged the patient's fee statement, hospitalization statement and related information reported to the medical insurance agency, the medical insurance agency audit, as a monthly pre-payment and year-end final accounts based on. The medical insurance agency will make monthly advance payments for the previous month's hospitalization and outpatient treatment of special diseases. Participants who are recognized as suffering from special diseases should go to a designated medical institution designated by the labor security department for medical treatment and purchase of medicines, and the medical expenses incurred will be recorded directly and settled instantly. (B) emergency settlement procedures participants due to emergency rescue to the city's non-designated medical institutions and foreign medical institutions hospitalization, medical expenses incurred by the individual or unit advance, emergency rescue after the end of the hospital emergency medical records, inspection, laboratory reports, invoices, a detailed list of medical charges, etc. health insurance agencies to reimbursement procedures in accordance with the provisions of the regulations. (C) Settlement procedures for relocated staff 1, relocated staff by their units to designate 1-2 designated medical institutions in their place of residence, and reported to the medical insurance agency for the record. 2. The medical expenses incurred by the relocated staff who are sick in the designated medical institutions in their place of residence shall be advanced by themselves or their units, and after the treatment is completed, the units shall hold the medical certificates of the insured persons and their medical records, valid bills, duplicate prescriptions, and lists of hospitalization expenses, and so on, and settle them with the social and medical insurance agencies on the specified dates. (D) referral and transfer settlement 1, the insured person due to the conditions of the designated medical institutions or due to specialized diseases to other medical institutions for diagnosis and treatment, need to fill out the referral and transfer approval form. By the attending physician to put forward the reasons for referral to the hospital, the section chief to put forward the views of referral to the hospital, the medical insurance office of the medical institution audit, the signature of the director in charge, reported to the Municipal Health Insurance Center for approval before the transfer of hospitals. 2, the principle of referral to the city after the city, the first province after the province. The city referral transfer provisions in the designated medical institutions. Out-of-town referrals must be made by the city's designated medical institutions above the third level.3. The medical expenses incurred by the participant after the referral to the hospital shall be advanced in cash by the individual or the unit, and after the end of the medical treatment, the participant or his/her agent shall reimburse the hospitalization expenses that are covered by the integrated fund to the medical insurance agency with the referral and transfer approval form, medical record certificate, prescriptions and valid documents.
Three, medical insurance reimbursement amount has a limit
Medical reimbursement is a limit, regardless of the type of people, outpatient, emergency large medical expenses paid for the cost of the maximum limit is 20,000 yuan per year. But the reimbursement rate varies for different groups of people. And the maximum payment for hospitalization is 70,000 yuan from the basic medical insurance fund within one year. Generally speaking, different regions have different economic development, so the reimbursement rate is also different, the following on the Beijing employee health insurance insurance rate situation. After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses above 1800 RMB after visiting the outpatient or emergency room of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If you are a retiree over 70 years of age, you can be reimbursed for expenses over $1,300. The reimbursement rate is 80%. For example, if you are an active employee and the cost of an outpatient visit is $2,500, then 50% of the $700 portion is reimbursed, which is $350. In the case of hospitalization expenses, the first time you use basic medical insurance to pay in a year in 2009, the starting amount is $1300 for both active employees and retirees. And for the second and subsequent hospitalizations, the starting rate is set at 50%, which is $650. The standard of hospitalization reimbursement is related to the level of the hospital in which the participant lives, such as living in a tertiary hospital, from the starting standard to 30,000 yuan of expenses, the employee pays 15%, that is, reimbursement of 85%; 30,000 yuan to 40,000 yuan of expenses, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan to the highest limit of payment of the portion of the cost, then 95% are reimbursed, the employee only has to pay 5%. The proportion of retiree personal payment is 60% of the active (that is, the above) employees, but the starting standard below, are paid by the individual. There is a cap on the amount of reimbursement for medical insurance, with a maximum limit of 20,000 yuan per year for outpatient care and 70,000 yuan per year for hospitalization. The above is a compilation of what is covered by the health insurance reimbursement, in summary, in the above content described what is not reimbursed by the health insurance, such as a variety of cosmetic, plastic surgery projects, orthopedic treatment programs and so on.