Outpatient visit more than 20 yuan can be reimbursed participants can enjoy outpatient reimbursement. Previously, only 31 diseases could be reimbursed on an outpatient basis. Starting April 1, all diseases covered by health insurance can be reimbursed. Medical insurance, generally referred to as basic medical insurance, is a social insurance system established to compensate workers for economic losses caused by the risk of illness. Through the employer and individual contributions, the establishment of a medical insurance fund, the insured person sick visit medical expenses incurred by the medical insurance organization to give them a certain amount of financial compensation.
I. The establishment and implementation of the basic medical insurance system gathers the economic strength of units and members of the community, coupled with government subsidies, which enables sick members of the community to obtain the necessary material assistance from the community to alleviate the burden of medical expenses, and prevents sick members of the community from "becoming poor because of illness". Medical insurance has the basic features of social insurance, such as compulsory, mutual aid and social nature. The medical insurance system is normally governed by national legislation, which makes its implementation compulsory and establishes a fund system, the costs of which are paid for by both employers and individuals***, and the medical insurance premiums are paid by the medical insurance organization, in order to address the medical risks posed by workers as a result of illnesses or injuries. The social medical insurance agency establishes a basic medical insurance individual account for each insured person, with the person's identity card number as the lifelong medical insurance number. The funds in an employee's basic medical insurance individual account are owned by the individual and are directed to medical consumption, with no compensation for overspending, a rolling balance, and no cash withdrawals. When an employee dies, the individual account is canceled and the balance is inherited in accordance with the regulations.
Second, the basic medical insurance for employees do not pay the cost of what
(A) service category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) consultation fee, examination and treatment expediting fee, surcharge for named surgery, quality and premium fee, self-invited special nurses and other special medical services.
(2) Non-disease treatment program category. (1) a variety of beauty, fitness items and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height projects; (3) a variety of health checkups; (4) a variety of preventive, health care clinic programs; (5) a variety of medical consultation, medical appraisal.
(C) diagnostic and treatment equipment and medical materials. (1) the application of positron emission tomography (PET), electron beam cT, ophthalmic excimer laser therapy and other large-scale medical equipment for examination and treatment programs; (2) glasses, dentures, eye prostheses, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, checking and treatment equipment; (4) the provincial pricing departments can not be charged separately for the disposable medical.
(4) treatment program category. (1) all kinds of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valve, cornea skin, blood vessels, bone, bone marrow transplantation; (3) myopic eye orthopedics; (4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
Third, the health insurance reimbursement exemptions
Self-medical treatment (not designated hospitals for medical treatment or do not apply for referral orders), self-purchase of drugs, public medical provisions can not be reimbursed for drugs and medical expenses not in line with the family planning; outpatient treatment costs, clinic fees, hospitalization costs, food costs, accompanied by the cost of nutritional expenses, blood transfusions (except for those who have a family blood bank, reimbursement in accordance with the relevant regulations), cold Heating and cooling costs, ambulance fees, special care costs and other costs; car accidents, fights, suicides, alcoholism, workplace accidents and medical malpractice medical costs; orthopedics, plastic surgery, dental implants, prosthetics, organ transplants, naming surgical fees, consultation fees, etc.; reimbursement of the scope of the portion of the limit outside the scope of reimbursement.
I hope the above will help you, if there are still questions you can consult a professional lawyer.
Legal basis:
The People's Republic of China Social Insurance Law
Article 2 of the State to establish a basic pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance and other social insurance system, to protect the citizens in the old age, disease, industrial injury, unemployment, childbirth and other situations in accordance with the right to obtain material assistance from the State and society.
Article 26: The standards of treatment for basic medical insurance for workers, new rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State.
Article 28: Medical expenses in accordance with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as emergency and rescue medical expenses shall be paid out of the basic medical insurance fund in accordance with state regulations.