When participating in medical reimbursement, insured workers need to apply for outpatient special disease identification. Workers in designated medical institutions to receive the Lhasa city urban workers basic medical insurance outpatient special disease identification and approval form "to fill in the relevant content, by the attending doctor to fill in the diagnosis and treatment opinions, and confirmed by the designated hospital doctors, attached to the relevant inspection, laboratory proof to the unit of political work and personnel departments to verify the signature, by the unit unified submitted to the medical insurance agencies for approval. After examination and approval, the insured workers shall go to the designated medical institutions with the approval form and medical insurance card and medical insurance card to enjoy the treatment of special outpatient diseases. The approved treatment cycle of outpatient special diseases is 180 days each time, and the dosage of each time does not exceed 15 days. There is no deductible line for medical expenses that meet the identification standards of 20 outpatient special diseases and meet the requirements of the catalogue, and the medical insurance fund pays 80% of the expenses of the insured employees.
In addition, the basic medical insurance will pay the medical expenses incurred as long as they are purchased at designated medical institutions and retail pharmacies and meet the scope of the basic medical insurance drug list, basic medical insurance diagnosis and treatment items and basic medical insurance medical service facilities standards. Among them, Class A drugs are fully reimbursed, and Class B drugs are reimbursed after the individual pays 10%, but the drugs that are not in the drug list are fully borne by the individual. The reimbursement rate of medical equipment and medical materials that meet the requirements of basic medical insurance is 98%. The highest standard of hospital bed fee is determined according to the level of hospitals, such as 80 yuan/day in tertiary hospitals, 60 yuan/day in secondary hospitals and 40 yuan/day in primary hospitals.
However, the basic medical insurance does not pay registration fees, case fees and other services, non-disease treatment items such as beauty and non-functional plastic surgery, diagnosis and treatment equipment such as glasses and artificial limbs, medical materials, myopia orthopedic treatment items, infertility (pregnancy) treatment or various scientific and clinically verified diagnosis and treatment items.
Xu Haiyuan, director of the Labor and Social Security Bureau of Lhasa, said that 36,033 urban residents in Lhasa participated in residents' medical insurance last year, and the number of people participating in residents' medical insurance this year reached 3,7091. In the past two years, * * * raised14,624,800 yuan, including 2,798,700 yuan for individuals and 1 18 for county-level financial subsidies. "At present, we have reimbursed hospitalization expenses of 4,202,500 yuan for 1 105 insured residents, with a total cost of 7,057,400 yuan, and the average reimbursement ratio of the overall fund is 60%."
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