If the colonoscopy is performed in an outpatient clinic, it can only be paid for with the individual account of the medical insurance, not with the integrated account of the medical insurance, of course, if the individual account of the medical insurance card has no money; then the relevant medical expenses can only be paid by the insured person. However, if you are hospitalized for a serious illness and have to undergo a colonoscopy, you can be reimbursed by the integrated account.
I, what is health insurance
Generally refers to the basic medical insurance, is to compensate for the economic losses caused by the risk of disease workers and the establishment of a social insurance system. Through the employer and individual contributions, the establishment of a medical insurance fund, the insured person is sick to visit the medical expenses incurred by the medical insurance organization to give them a certain amount of economic compensation. The establishment and implementation of the basic medical insurance system gathered the economic strength of the unit and members of the community, coupled with the government's financial support, can make the sick members of the community from the community to obtain the necessary material help, reduce the burden of medical expenses, to prevent the sick members of the community, "due to illness to poverty".
Second, the cost items reimbursed by the medical insurance are
1, the bed fee is up to 12 yuan/day in township health centers, and up to 15 yuan/day in municipal and above municipal medical institutions.
2. The scope of drug use for the drug fee is in accordance with the drug catalog stipulated by the province.
3, inspection 360 Q&A fee inspection, laboratory tests, etc., the limit of 600 yuan.
4, the treatment fee of 300 yuan or less according to the actual settlement, 300 yuan or more part of the reimbursement of 50% into the scope of reimbursement.
5. Surgical fees are based on the prescribed fee schedule.
6, blood transfusion fee surgery or rescue, each hospitalization maximum limit of 500 yuan.
7. Material costs are subject to a maximum of RMB 2,000 per hospitalization.
8. Outpatient expenses for radiotherapy, chemotherapy and dialysis required for kidney failure of patients with various tumors will be compensated as if they were hospitalized.
Three, the difference between the new rural medical insurance and urban medical insurance is as follows
1, the crowd is different. Urban residents health insurance is mainly to cover urban residents, the new rural health insurance is mainly to cover rural residents;
2, different management departments. The urban residents' health insurance is mainly managed by the human resources and social welfare departments, and the new rural cooperative medical insurance is managed by the health departments in most places;
3. The purchasing methods are different. The new rural cooperative medical care is the rural household to buy, resident medical insurance is non-agricultural household to buy;
4, reimbursement rate is different. The reimbursement rate of urban residents' medical insurance is 85%, and the reimbursement rate of NRCM ranges from 10% to 80% according to different levels of hospitals;
5. The reimbursement of medicines is different. The reimbursable drug catalog of NHI is less than that of urban health insurance, and the reimbursement ratio of NHI in township hospitals is high, and the average reimbursement ratio in municipal hospitals is 10-20% lower than that of urban health insurance, and the maximum ceiling is also less than that of urban health insurance;
6, the protection of treatment focuses on the different. The urban residents' health insurance is mainly to protect the hospital and outpatient treatment of major diseases and general outpatient, so the hospitalization and outpatient treatment of major diseases are higher than the new rural cooperative. In addition, the outpatient treatment level of the new rural cooperative is generally higher than the urban residents' medical insurance.
Four, gastroenteroscopy is a self-pay program
1, usually the general population in the outpatient gastroenteroscopy are self-pay. During the hospitalization period to do ordinary gastroenteroscopy, medical insurance can be reimbursed, painless gastroscopy of anesthesia drugs need to pay. It varies from region to region, some places can be reimbursed, the specific should consult the local hospital.
2, ordinary gastroenteroscopy is simple, fast and affordable, there may be vomiting, nausea and other manifestations, and due to some of the examinee can not tolerate may affect the examination process. The price of an ordinary gastroenteroscopy is usually between 500 and 700, and the price may vary from hospital to hospital.
3, painless gastroenteroscopy, in the examination process is more comfortable, conducive to the doctor to carry out a careful examination, but need to use anesthesia, the price is higher, the anesthesia is required to self-pay. The total **** of painless gastroenteroscopy is about 1500 to 2000, the specific price should consult the local hospital.
4, gastroenteroscopy whether self-pay should be combined with personal and hospital conditions, you can go to the hospital or physical examination center for detailed consultation.
Fifth, the medical insurance can not be reimbursed for the project
1, is the category of services: registration fees, out-of-hospital consultation fees, medical records, etc.; clinic fees, examination and treatment of expedited fees, named surgery surcharges, named surgery surcharge, quality premium fee, self-employment of special nurses and other special medical services.
2. Non-disease treatment programs: various beauty and fitness programs as well as non-functional plastic surgery, orthopedic surgery, etc.; various weight loss, weight gain, height increase programs; various health reimbursement; a variety of preventive, health care treatment programs; a variety of medical consultation, medical appraisal.
3, is the diagnosis and treatment equipment and medical useful materials: the application of positron emission tomography device (PET), electron beam CT, ophthalmic excimer laser treatment instrument and other large-scale medical equipment for the examination and treatment program. Eyeglasses, denture, eye prosthesis, prosthetic limbs, hearing aids and other rehabilitative devices. All kinds of self-use health care, massage, examination and treatment equipment. Provincial price departments do not charge separately for disposable medical materials.
4, is the category of therapeutic projects: all kinds of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues outside the transplantation; myopic orthopaedics; qigong therapy, music therapy, health care nutrition therapy, magnetic therapy and other complementary therapeutic projects.
5, is the other categories: a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; a variety of scientific research, clinical verification of the diagnosis and treatment program.
Legal basis
The Chinese People's **** and State Social Insurance Law
Article 24 of the State to establish and improve the new rural cooperative medical system.
Methods for administering the new type of rural cooperative medical care shall be prescribed by the State Council.
Article 28 Medical expenses that are in accordance with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29: The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Article 58 An employer shall, within thirty days from the date of employment, apply for social insurance registration for its employees with the social insurance administration organization. If the employer fails to register for social insurance, the social insurance agency shall approve the social insurance premiums to be paid by the employer.
Individual industrial and commercial households without employees who voluntarily participate in social insurance, part-time employees who do not participate in social insurance with their employers, and other flexibly employed persons shall apply to the social insurance administrative organization for social insurance registration.
The State establishes a nationally unified individual social security number. The personal social security number is a citizen's identity number.