Two, ophthalmology reimbursement
Ophthalmology can be reimbursed, in accordance with the relevant provisions of the health insurance department, ophthalmology belongs to the scope of reimbursement of health insurance, eye examination, treatment, prescription drugs are within the scope of reimbursement of the health insurance, the health insurance department will be based on the provisions of the health insurance, reimbursement according to a certain percentage, so in the eye to see a doctor, should be using the card, the need to reimbursement of the health insurance by the health insurance The department of reimbursement.
Three, eye surgery belongs to the scope of medical insurance reimbursement
Do myopic eye surgery medical insurance can not be reimbursed, this is not the scope of medical insurance disease. The actual eye is usually a lot more than a few of the most common and also the most popular. The actual eye surgery is not covered by the medical insurance, but the eye surgery such as retinal detachment can be reimbursed, as well as cataract surgery can be reimbursed partially.
Four, medical insurance card reimbursement scope
(a) basic medical insurance drug reimbursement
Basic medical insurance coverage of drugs, divided into two types of Class A and Class B. The first is the basic medical insurance coverage of drugs, the second is the basic medical insurance coverage of drugs, the second is the basic medical insurance coverage of drugs. Class A drugs are those that are basically standardized across the country and can ensure the basic needs of clinical treatment. The costs of these drugs are covered by the basic medical insurance fund and are paid according to the basic medical insurance payment standards.
The catalog of Class B drugs is adjusted by provinces, autonomous regions and municipalities directly under the central government according to their own conditions. These drugs are first paid for by employees at a certain percentage before being included in the scope of the basic medical insurance fund and paid for according to the standard of payment of the basic medical insurance.
The following medicines are excluded from the basic medical insurance reimbursement scope:
1, the main role of nutritional tonic medicines;
2, part of the animal and animal organs that can be used as medicines, dried (water) fruits;
3, all kinds of alcohol preparations made from Chinese herbs and Chinese medicine tablets;
4, all kinds of medicines in the fruit-flavored preparation, oral effervescent;
5, the blood of the blood of the people in the hospital;
5, the blood of the people in the hospital;
5, the blood of the people in the hospital. p>
5, blood products, protein products (except for special indications and first aid, rescue);
6, the social insurance administrative department stipulates that the basic medical insurance fund does not pay for other drugs.
(2) basic medical insurance treatment program reimbursement
1, the basic medical insurance treatment program should meet the following conditions:
(1) clinical diagnosis and treatment must be, safe and effective, and the cost is appropriate;
(2) by the price department to set the charges;
(3) by the fixed-point medical institutions for the insured to provide fixed-point medical service within the scope.
2. The scope of diagnostic and treatment items for which the basic medical insurance pays part of the expenses is determined in accordance with the Scope of Diagnostic and Treatment Items of Basic Medical Insurance stipulated by the state. If the expenses are within the catalog of diagnostic and therapeutic items paid by the basic medical insurance, the insured person shall first pay out of pocket in accordance with the prescribed proportion and then pay according to the provisions of the basic medical insurance. The basic medical insurance fund will not pay for those within the catalog of diagnostic and therapeutic items that are not paid for by the basic medical insurance.
(C) Reimbursement of basic medical services
The reimbursement of basic medical insurance medical service facilities covers the living service facilities provided by the designated medical institutions, which are necessary for the participants in the process of diagnosis, treatment and care, including inpatient hospitalization beds or beds for outpatient (emergency) observation.
The costs of living service items and service facilities that are not paid by the basic medical insurance fund mainly include:
1, transportation fees for consultation (referral) and emergency ambulance fees;
2, air-conditioning fees, television fees, telephone fees, infant warming box fees, food warming box fees;
3, escort fees, nursing fees, cleaning fees, and outpatient decoctions fees;
4. Meals;
5. Recreational activities and other special needs living services.
Legal Basis
Article 27 of the Social Insurance Law of the People's Republic of China (PRC): Individuals participating in basic medical insurance for employees who have reached the statutory retirement age and have paid contributions for a total of up to a certain number of years as stipulated by the state, will no longer be required to pay basic medical insurance premiums and will be entitled to basic medical insurance in accordance with the state's regulations; those who have not yet reached the prescribed number of years will be allowed to make contributions for a period of time. If they have not yet reached the national prescribed limit, they may contribute until the national prescribed limit.
Article 28 of the basic medical insurance drug list, diagnostic and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.