A basic medical insurance to pay part of the cost of the diagnosis and treatment items
(A) diagnosis and treatment equipment and medical materials
1, the application of X-ray computed tomography (CT), stereotactic radiography (Y knife, X knife), cardiac and angiographic X-ray machine (including digital) Subtraction equipment), magnetic **** vibration imaging device (MRI), single photon emission computer scanning device (SPECT) color Doppler, medical linear gas pedal and other large-scale medical equipment for the examination, treatment, and examination, treatment hall cost unit price of more than 200 yuan.
2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy.
3, cardiac pacemaker, artificial joints, artificial crystals, vascular stents and other body replacement of artificial organs and materials placed in the body. If imported artificial organs and materials are used, the cost will be reimbursed according to the price of domestic artificial organs and materials; if there is no domestic price, the cost will be reimbursed at 50% of the imported price.
4. Disposable medical materials that can be charged separately as stipulated by the provincial price department.
(2) therapeutic items category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valve, cornea, skin, blood vessel, bone, bone marrow transplantation;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy items;
the above items individual out-of-pocket ratio is generally 10-30%, the specific proportion is determined by each coordinating region. The settlement of medical expenses can be paid by the individual in accordance with the stipulated percentage, and the balance will be reimbursed in accordance with the relevant provisions of the basic medical insurance.
II. Diagnostic and treatment items not covered by basic medical insurance
(I) Service items
1. Registration fees, medical record fees, and out-of-hospital consultation fees.
2. Fees for consultation, expedited examination and treatment, surcharges for named surgery, quality premiums, and fees for special medical services such as hiring special nurses on one's own.
3. Other medical service fees other than those stipulated by the provincial price department for medical institutions.
(2) non-disease treatment program category
1, a variety of beauty, fitness programs and non-functional cosmetic and orthopedic surgery. Treatment of pigmented spots, black spots, freckles, acne, stuttering, snoring, cleft lip, nevus, armpit odor, hirsutism, to the eye, squint, myopia, amblyopia, eye mutilation, blepharoplasty, playing the ear eye, remove moles, laser cosmetic warts. Wrinkle removal, cosmetic massage, teeth cleaning, dental veneers, teeth irregularities correction, discoloration of teeth, black and yellow teeth treatment; treatment of congenital slanting neck, congenital deformed feet, flat feet, O-legs, X-legs, polydactyly, limb stumps cost.
2, a variety of weight loss, fat gain, height increase program. Such as the cost of growth assistance, wisdom, thinness, dietary therapy.
3, various health checkups.
4, a variety of preventive, health care treatment programs.
5, a variety of medical consultation, medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser treatment device and other large-scale medical equipment for the examination and treatment program.
2, eyeglasses, dental prostheses, eye prostheses, prosthetic limbs, hearing aids and other rehabilitative appliances.
3, a variety of self-use health care, massage, examination and treatment equipment.
4, the provincial price department regulations can not be charged separately disposable medical materials.
(4) therapeutic items category
l, all kinds of organ or tissue transplantation of organ source or tissue source and its surgical costs.
2. Transplantation of organs or tissues other than kidney, heart valve, cornea, skin, blood vessel and bone marrow transplantation.
3. Orthopedic surgery for myopia.
4. Complementary therapeutic programs such as qigong therapy, music therapy, health care nutritional therapy, and magnetic therapy.
(E) other
1, a variety of infertility (pregnancy), sexual dysfunction treatment program.
2, a variety of scientific research, clinical verification of the treatment program.
3. Super family planning fees.
4, various meetings of the medical expenses.
5, institutions, enterprises and public institutions set up their own Red Cross box drug fees
6, drugs. Narcotic drug addiction, alcoholism, drug rehabilitation, smoking cessation and other costs.
7, due to crime, fighting, traffic accidents, medical accidents, intentional suicide. Self-inflicted injuries and fireworks and firecrackers disability and other costs incurred.
8. Medical expenses incurred during business trips or leave of absence due to emergency hospitalization beyond the prescribed time limit without completing the procedures for outpatient treatment, as well as medical expenses not reimbursed beyond the prescribed time limit across the year, and medical expenses incurred prior to the entry into force of the medical insurance card and during the period of loss.
9. All expenses incurred for new examination and treatment programs without the approval of the price and health administration departments, as well as unauthorized increase of charges; charges for government-priced medicines beyond the stipulated retail price; and charges for other medicines beyond the stipulated retail price.
10. Medical expenses incurred during study tours abroad and trips to Hong Kong, Macao and Taiwan for further study, lectures, family visits and travel.
11. If the participant's hospitalization is completed and the participant should be discharged from the hospital but refuses to be discharged, and the hospital's medical technical appraisal team confirms that the completion of the treatment is established, the medical expenses incurred from the day after the appraisal is confirmed to the day after the appraisal and thereafter, and the hospitalization expenses incurred by the participant's titled hospitalization and those that do not comply with the criteria for hospital admission.
12. Medical expenses not related to the condition during treatment.
13. Hospitalization bed charges exceeding the prescribed standard.
14. Medical expenses that do not comply with the regulations on referral and transfer of patients to other hospitals and those for which no formalities have been carried out.
15. Other expenses not covered by the Employees' Basic Medical Insurance Fund.