I, the basic insurance does not pay the cost of the scope of treatment items:
(a) the service category
1, registration fees, out-of-hospital consultation fees, medical records, such as the cost of books;
2, visit fees, examination and treatment of expedited fees (except for emergencies), naming the surgical surcharges, high-quality and premium fees, self-requested special nurses fees and other special needs of the medical services.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness program and messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase the height of the project;
3, a variety of health checkups;
4, a variety of preventive, health care diagnostic and therapeutic programs;
(C) diagnostic and therapeutic equipment and medical materials
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 of the project;
2, eyeglasses, dental prostheses, eye prostheses, prosthetic limbs, hearing aids, and other rehabilitation appliances;
3, all kinds of health care for their own use, massage, examination, rehabilitation and treatment of the device.
(D) therapeutic project category
1, all kinds of organ transplantation or tissue transplantation of organ or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues;
3, myopic orthopaedics;
4, qigong therapy, music therapy, health care, nutritional therapy, magnetic therapy and other complementary therapies therapy, magnetic therapy and other complementary treatment programs.
(E) other
1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, a variety of scientific research, clinical verification of diagnosis and treatment programs;
The scope of basic medical insurance to pay for a portion of the cost of diagnosis and treatment programs:
(A) Diagnostic and treatment equipment and medical materials
1, X-ray computed tomography (CT) device (X-rays) Ray computed tomography (CT), stereotactic radiography (γ-knife, χ-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single-photon emission computerized scanning device (SPECT), color Doppler, medical linear gas pedal, and other large-scale medical equipment for the examination, treatment projects;
2. >2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3, pacemakers, artificial joints, artificial crystals, vascular stents in vivo replacement of artificial organs, in vivo placement of materials;
4, the provincial pricing department can be charged separately for disposable medical materials.
(B) treatment project category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Hearing aids and other rehabilitation appliances;
3, a variety of self-use health care, massage, check rehabilitation and treatment equipment.
(C) other
1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program;
2, a variety of scientific research, clinical verification of diagnosis and treatment program;
three, the following are not rural cooperative medical insurance reimbursement:
1, self-medicating (not designated hospitals for medical treatment or referral orders), self-purchase of drugs, The medical expenses that cannot be reimbursed under the public medical care regulations and those that are not in accordance with family planning;
2. Other expenses such as outpatient treatment fee, consultation fee, hospitalization fee, meal fee, companion fee, nutritional fee, blood transfusion fee (except for those who have blood storage at home, which will be reimbursed in accordance with the relevant regulations), heating and cooling fee, ambulance fee and special nursing fee;
3. Medical expenses for car accidents, fights, suicides, alcoholism, workplace accidents and medical accidents;
4. Medical expenses for medical malpractice;
4. Orthopedics, plastic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, etc.;
5. Reimbursement is within the scope of reimbursement, and the portion outside the limit.
Legal basis:
The People's Republic of China*** and the State Social Insurance Law
Article 28 The medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities as well as those of the emergency and rescue shall be paid out of the basic medical insurance fund in accordance with the state regulations.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.