A, employee health insurance maximum limit how much
Medical insurance reimbursement scope: in the occurrence of more than the basic medical co-ordination fund maximum payment limit above the medical expenses, by the social insurance department according to: 0-40,000 yuan reimbursement of 85% of the following 40,000 yuan -80,000 yuan reimbursement of 90% of the following 80,000 yuan reimbursement of 95% of the above 80,000 yuan reimbursement. The maximum payment limit is RMB 150,000 in each medical year. According to the relevant provisions, all enterprises belonging to municipalities and districts and counties within the administrative area of the city (hereinafter referred to as enterprises) and their employees and retirees are eligible for the medical insurance for major diseases. Retirees who do not pay basic medical insurance premiums and continue to enjoy basic medical insurance benefits are not covered by the "medical insurance for major diseases".The scope of treatment items that are not covered by the employee health insurance
(a) service items 1, registration fees, out-of-hospital consultation fees, medical records and other fees; 2, consultation fees, examination and treatment of expedited fees (except for emergencies), surcharges on named surgeries, high quality and premium fees, self-employment of special nurses, and other special medical services.These fees are for the purpose of providing medical services to the patients.
(B) non-disease treatment program category 1, a variety of beauty (cosmetic life, medical cosmetology) fitness program and messy non-functional plastic surgery, orthopedic surgery, etc.; 2, a variety of weight loss, gain weight, increase in height project. 3, a variety of health checks. 4, a variety of preventive, health care diagnostic and treatment programs. 5, dental orthodontics, dental porcelain. 6, a variety of medical consultations (excluding psychiatric consultations), medical identification. (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 inspection and treatment programs. 2, eyeglasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitative devices. 3, a variety of self-use health care, massage, check rehabilitation and treatment equipment. (D) therapeutic items category 1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source; 2, in addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation, other organs or tissue transplantation. 3, myopic eye orthopedics. 4, qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic programs. (E) other 1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs. 2, a variety of scientific research, clinical verification of the treatment program.Three, employee health insurance to pay part of the cost of diagnostic and treatment programs range
(a) diagnostic and treatment equipment and medical materials: 1, the application of X-ray computed tomography (CT), stereotactic radiography devices (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-scale medical equipment for the examination, treatment projects; 2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy. 3, pacemakers, artificial joints, artificial crystals, vascular stents within the replacement of artificial organs, materials placed in the body. 4, the provincial price department can be charged separately for 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. (c) single cost of more than 400 yuan of medical instruments and equipment for examination, treatment programs and medical materials. These are the knowledge we have in this area. I hope this article of mine can bring you help. If you want to know more about these aspects, you can also go to the Internet to search query.