1. Service category.
(1) registration fee, out-of-hospital consultation fee, medical record cost, etc..
(2) Special medical services such as visit fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, and self-invited special nurse.
2. Non-disease treatment program category.
(1) beauty, fitness items and non-functional cosmetic and orthopedic surgery.
(2) a variety of weight loss, fat, height projects.
(3) All kinds of health checkups.
(4) Various preventive and health care treatment programs.
(5) All kinds of medical consultation and medical appraisal.
3, diagnostic and treatment equipment and medical materials.
(1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapeutic instrument and other large-scale medical equipment for the examination and treatment program.
(2) Eyeglasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitative devices.
(3) Various kinds of health care, massage, examination and treatment instruments for self-use.
(4) Provincial price department regulations can not be charged separately for disposable medical use.
4, treatment program category.
(1) all types of organ or tissue transplantation organ source or tissue source.
(2) In addition to kidney, heart valve, cornea skin, blood vessel, bone, bone marrow transplantation other organs or tissue transplantation.
(3) Orthopedic surgery for myopia.
(4) Complementary therapeutic programs such as qigong therapy, music therapy, nutrient therapy for health care, and magnetic therapy.
5. Others.
(1) a variety of infertility (pregnancy), sexual dysfunction treatment program.
(2) a variety of scientific research, clinical verification of the treatment program.
Rural health insurance reimbursement scope:
1, outpatient compensation:
(1) 60% reimbursement for visits to village health centers and village central health centers, with a limit of 10 yuan per visit for prescription medication, and a limit of 50 yuan for temporary rehydration of prescription medication by a doctor at the health center.
(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 will be 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 cost, with a limit of RMB 50 for each examination and operation and RMB 200 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, radiography, laboratory tests, physiotherapy, 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, the elderly over 60 years of age hospitalized in Xingta Township Health Center, treatment and nursing fees are compensated 10 yuan per day, with a limit of 200 yuan.
(2) Reimbursement rate: town health center reimbursement 60%; secondary hospital reimbursement 40%; tertiary hospital reimbursement 30%.
3. Compensation for major illnesses
(1) Compensation from the town's risk fund: Any hospitalized patient who participates in the rural cooperative medical insurance will be compensated for the one-time or yearly cumulative reportable medical expenses of more than 5,000 yuan in segments, i.e., 65% of 5,001-10,000 yuan, and 70% of 10,001-18,000 yuan.
(2) The annual limit of 11,000 yuan for compensation for township cooperative medical care inpatient and outpatient blood dialysis for uremia, and outpatient radiotherapy and chemotherapy for oncology is 11,000 yuan.
Legal basis
The People's Republic of China*** and the State Social Insurance Law
Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) Those that should be paid from the industrial injury insurance fund;
(2) Those that should be borne by a third party;
(3) Those that should be borne by the public***health burden;
(iv) medical treatment outside the country.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.