1, service item class
(1) Registration fee, out-of-hospital consultation fee, medical record fee, etc.
(2) special medical services, such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and self-invited intensive care;
2. Non-disease treatment projects
(1) All kinds of beauty (life beauty, medical beauty) bodybuilding projects, as well as disorderly non-functional plastic surgery and orthopedic surgery.
(2) various weight loss, weight gain and height increase projects;
(3) various health checks; ;
(4) All kinds of preventive health care and diagnosis projects.
(5) Registration fee, out-of-hospital consultation fee, medical record fee, etc. ;
(6) Special medical services such as visiting fees, expedited fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and self-invited intensive care;
3. Non-disease treatment projects
(1) All kinds of beauty (life beauty, medical beauty) bodybuilding projects, as well as disorderly non-functional plastic surgery and orthopedic surgery.
(2) various weight loss, weight gain and height increase projects;
(3) various health checks;
(4) all kinds of preventive health care and diagnosis projects;
(5) Orthodontics and porcelain;
(6) all kinds of medical consultation (excluding psychiatric consultation) and medical appraisal.
4, diagnosis and treatment equipment and medical materials
(1) Use positron emission tomography, electron beam CT, ophthalmic excimer laser therapeutic apparatus and other large medical equipment for examination and treatment projects;
(2) glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation devices;
(3) all kinds of self-use health care, massage, examination, rehabilitation and treatment equipment;
5, treatment project category
(1) Organ or tissue sources of various organ transplants or tissue transplants;
(2) Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
(3) Orthopedic surgery for myopia;
(4) Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects;
6. Others
(1) various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
(2) all kinds of scientific research and clinical verification of diagnosis and treatment projects.
The scope of non-reimbursement usually includes the following aspects:
1, medical expenses incurred in outpatient service, emergency service, in-hospital observation and family sickbed;
2. The medical expenses for one week after being transferred from the emergency hospital;
3. Medical expenses paid by insurance funds such as work injury and maternity;
4. Medical responsibilities that should be borne by a third person or individual;
5, the burden of foreign medical expenses and other expenses that will not be reimbursed.
To sum up, the reimbursement scope of urban medical insurance is still relatively wide, including not only the general outpatient and examination expenses, but also the later medical and hospitalization expenses. However, medical insurance reimbursement requires medical treatment in qualified hospitals, and medical treatment in unqualified hospitals may not be reimbursed. In addition, cosmetic surgery cannot be reimbursed.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.