Myopia surgery medical insurance is not reimbursable.
I, rural health insurance reimbursement
1, outpatient reimbursement:
(1) village health clinic and village center health clinic visit reimbursement of 60%, each visit to the prescription drug cost limit of 10 yuan, the health center doctor temporary rehydration of prescription drug cost limit of 50 yuan.
(2) Township health centers will be reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.
(3) Secondary hospitals are reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.
(4) Tertiary hospitals will reimburse 20% of the fees, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.
(5) Chinese medicine invoices with prescription attached are limited to RMB 1 yuan per sticker.
(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.
2. Hospitalization Compensation
(1) Reimbursement Scope:
A. Pharmaceutical Fees: Auxiliary Examinations: Limit of 200 RMB for each examination fee such as EKG, X-ray fluoroscopy, radiographs, laboratory tests, physical therapy, acupuncture, CT, MR*** vibration, etc.; Surgical Fees (with reference to the national standard, reimbursement for fees in excess of 1,000 RMB will be made in accordance with the limit of 1,000 RMB).
B. For the elderly over 60 years old who are hospitalized in Xingta Township Health Center, the treatment fee and nursing fee are compensated 10 yuan per day with a limit of 200 yuan.
(2) Reimbursement rate:
The town health center reimburses 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%.
The following are excluded from the reimbursement scope of the rural cooperative medical insurance:
1. Medical expenses for self-medical treatment (medical treatment at unspecified hospitals or without referral orders), self-acquired medicines, medicines not reimbursable under the provisions of public medical care and medical expenses not in accordance with family planning;
2. Outpatient treatment expenses, consultation fees, hospitalization fees, meal expenses, accompanying guest fees, nutritional fees, blood transfusion fees (except for those who have blood stored in the family) and blood storage in accordance with the relevant provisions of the law. Except for those who have family blood storage, they will be reimbursed according to the relevant regulations), air-conditioning and heating expenses, ambulance fees, special nursing fees and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, work accidents and medical malpractice;
4. Orthopedics, plastic surgery, dental implants, prosthetics, organ transplants, naming surgical fees, consultation fees and so on;
5. Reimbursement of expenses within the scope of reimbursement, and the portion of reimbursement outside of the limit.
Two, urban health insurance reimbursement
The scope of urban health insurance reimbursement refers to all urban employers, as follows:
1, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.);
2, organs, institutions, social organizations, private non-enterprise units and their employees, are required to participate in the basic
3. Some cities and towns have stipulated that township and village enterprises and their employees, as well as owners of self-employed economic organizations in cities and towns and their employees, should gradually be included in the scope of basic medical insurance (the last of which varies according to the policies of each locality), so that they can enjoy medical reimbursement.
The urban medical reimbursement mainly refers to is in the hospital to see a doctor, medicine, hospitalization, surgery, etc., can be through the medical insurance card in accordance with the relevant provisions of the medical cost reimbursement, urban medical insurance is more specialized, the project size and coverage is larger, but it is in the major illnesses or accidents in the limited payout, this time the author suggests that the participants can be purchased separately from the commercial catastrophic medical supplement insurance and social security The combination of the way to reduce their financial losses.
Expanded information:
Employee health insurance reimbursement
A basic insurance does not pay for the cost of the scope of the medical treatment program
(a) the service category
1, registration fees, out-of-hospital consultation fees, medical records, such as the cost of books;
2, consultation fees, examination and treatment of emergency charges ( Except for emergency treatment), surcharge for named surgery, quality and premium fee, fee for hiring special nurses, and other special medical services.
(2) Non-disease treatment programs
1, various beauty (life beauty, medical beauty) and fitness programs as well as non-functional cosmetic surgery, orthopedic surgery, etc.;
2, various weight loss, weight gain, height increase programs;
3, various health checkups;
4, a variety of preventive, health care treatment programs; registration fees, consultation fees, medical records, and other fees. Consultation fees, medical records and other fees;
(3) diagnostic and treatment equipment and medical materials
1, the application of positron emission tomography, 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 self-consuming Health care, massage, examination rehabilitation and treatment apparatus.
(4) therapeutic items category
1, all kinds of organ transplants or tissue transplants of organ or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplants, other organs or tissue transplants;
3, orthopedics for myopia;
4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other complementary therapies therapy, magnetic therapy and other complementary treatment programs.
(5) 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;
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