reimbursement scope of medical insurance in 216
I. Qifubiaozhun for major medical insurance for employees
For chronic diseases, special diseases and major diseases in Zigong, the annual Qifubiaozhun is 7 yuan. Class A and general diagnosis and treatment need to pay 8%, class B is 75% and sophisticated is 7%.
the maximum payment limit is 5, yuan. These include hospitalization, outpatient chronic diseases, special diseases and major diseases.
III. Diagnosis and treatment equipment and medical materials
1. Inspection and treatment projects with large medical equipment such as positron emission tomography (PET), electron beam cT and ophthalmic excimer laser therapeutic apparatus;
2. Rehabilitation appliances such as glasses, dentures, artificial eyes, artificial limbs and hearing AIDS;
3. Various self-use health care, massage, examination and treatment instruments;
4. The provincial price departments stipulate that it is not possible to charge separately for disposable medical treatment.
IV. Treatment items
1. Organ source or tissue source of various organ or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneal skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
V. Other categories
1. Diagnosis and treatment items of various infertility (pregnancy) and sexual dysfunction;
2. Various scientific research and clinical verification diagnosis and treatment projects.
II. Items that are not reimbursed by medical insurance
Services
1. Registration fee, consultation fee outside the hospital, medical record cost, etc.
2. Special medical services, such as visiting fees, urgent fees for examination and treatment, additional fees for roll call operation, high quality and good price, and self-invited special nurses.
Non-disease treatment items
1. Various cosmetic and bodybuilding items, as well as non-functional plastic surgery and orthopedic surgery;
2. Various weight loss, weight gain and height increase projects;
3. Various physical examinations;
4. Various preventive and health care diagnosis and treatment projects;
5. All kinds of medical consultation and medical appraisal.
reimbursement process of medical insurance for employees in p>216
I. reimbursement process of employees in hospital
First, you need to show your medical insurance card, and then pay the fees according to the regulations of the hospital. After discharge, you can settle at the medical insurance office of the hospital and enjoy medical insurance benefits.
ii. reimbursement process for hospitalization in different places
(1), declaration and settlement materials
Please bring the following materials for reimbursement for hospitalization in different places
1. Invoice for settlement of hospitalization (stamp)
2. Detailed list of hospitalization expenses (stamp)
3. Discharge record (stamp)
4. Use of drugs and special diagnosis and treatment items outside the catalogue.
(2) and settlement of the medical insurance referral form for urban workers in the district
The hospitalization procedures in different places are complete, and the reimbursement will be settled after 5 working days with the receipt and my ID card (the consignee needs to provide the ID card of the consignee). Reimbursement will be suspended from 28th to the end of each month, and resumed on 1st of the following month.
Third, reimbursement procedures for outpatients with severe diseases
1. Reimbursement time
Reimbursement time for outpatients with hypertension and diabetes: March in the first quarter; The second quarter is June; The third quarter is September; The fourth quarter is December.
outpatient patients with severe diseases of other diseases are reimbursed once a month.
2. declare settlement information
① outpatient medical receipt;
2. The Chinese prescription shall be marked with unit price and sealed;
3. Check the original attached inspection report.
3. Settlement
After five working days, the settlement reimbursement amount will be directly transferred to my bank passbook
Further reading: How to buy insurance, which is better, and I will teach you how to avoid these "pits" of insurance.