I. The scope of treatment items for which the basic insurance does not cover the costs.
(I) Service items
1, registration fee, out-of-hospital consultation fee, medical record cost;
2, consultation fee, examination and treatment expediting fee (except for emergency), surcharge on named surgery, high quality and premium fee, self-invited special nurses fee, and other special medical services.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness program as well as messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase the height of the project;
3, a variety of health checkups;
4, a variety of preventive, health care clinic project;
5, dental orthodontics, dental porcelain;
6, a variety of medical consultations (excluding psychiatric consultations), medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the inspection and treatment program;
2, glasses, dentures, prosthetic eyes, prosthetics, hearing aids and other rehabilitation appliances;
3, a variety of health care for their own use, massage, inspection and rehabilitation and treatment equipment.
(D) therapeutic project category
1, all kinds of organ transplantation or tissue transplantation of organ or tissue source;
2, in addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation;
3, myopic orthopaedics;
4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other complementary therapies therapy, magnetic therapy and other complementary treatment programs.
(E) other
1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, a variety of scientific research, clinical verification of diagnosis and treatment programs;
2, basic medical insurance to pay part of the cost of the diagnosis and treatment program range
(A) diagnostic and therapeutic equipment and medical materials
1, the application of X-ray computed tomography devices, and other medical equipment. -ray computed tomography (CT), stereotactic radiography (γ-knife, χ-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single-photon emission computerized scanning device (SPECT), Color Doppler, medical linear gas pedal and other large medical equipment for examination, treatment projects;
2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3, pacemakers, artificial joints, artificial crystals, vascular stents in vivo replacement of artificial organs, in vivo replacement of materials;
4, the provincial price department can be charged separately for disposable medical materials.
5, the provincial price department can charge separately for the disposable medical materials.
(B) treatment project category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Legal basis
The People's Republic of China **** and the State Social Insurance Law
Article 28 The medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities as well as the emergency and rescue shall be paid from the basic medical insurance fund in accordance with the 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 by the social insurance administration organization with the medical institutions and drug business units.