A, dental fillings do not belong to the scope of health insurance reimbursement, so can not be reimbursed, dental fillings are not reimbursable items such as health insurance.
Second, the medical insurance can not be reimbursed for the project into the following:
(1) the service category: registration fee, out-of-hospital consultation fees, medical records cost, etc.; clinic fees, examination and treatment of the expedited fee, naming the surgery surcharge, naming the surgery surcharge, quality premium fee, self-referred special nurses and other special needs medical services.
(2) non-disease treatment programs: various beauty, fitness programs and non-functional plastic surgery, orthopedic surgery, etc.; a variety of weight loss, weight gain, height projects; a variety of health body reimbursement; a variety of preventive, health care treatment programs; a variety of medical consultation, medical appraisal.
(3) Diagnostic and treatment equipment and medical materials: the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser treatment instrument and other large-scale medical equipment for the examination and treatment program. Eyeglasses, denture, eye prosthesis, prosthetic limbs, hearing aids and other rehabilitative devices. All kinds of self-use health care, massage, examination and treatment equipment. Disposable medical materials that are not charged separately by the price department of each province.
(4) therapeutic project category: all kinds of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues; myopic eye orthopedics; qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.
(5) Other categories: a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs; a variety of scientific research, clinical verification of the diagnosis and treatment programs.
Expanded information:
Reimbursement conditions
Article 28 of the Social Insurance Law stipulates that the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, as well as emergency and emergency treatment facilities, should be in line with the basic medical insurance. service facilities standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.?
According to the basic requirements for the payment of basic medical insurance benefits in China, the reimbursement of medical expenses incurred by the insured person for medical treatment by the medical insurance organization generally has to comply with the following conditions:
(1) The insured person has to go to the designated medical institutions for medical treatment and purchase of medicines under the basic medical insurance or go to the designated retail pharmacies determined by the social insurance organization with the prescription issued by doctors of designated hospitals to purchase medicines. The purchase of medicines.
(2) Medical expenses incurred by insured persons in the course of seeking medical treatment must be in accordance with the scope and payment standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, in order to be paid by the basic medical insurance fund in accordance with the regulations.
(3) The portion of medical expenses incurred by a participant in accordance with the scope of payment of basic medical insurance that are above the starting standard and below the maximum payment limit of the social medical insurance fund shall be paid by the social medical insurance fund in a uniform proportion.
Reimbursement Ratio
1. Outpatient and Emergency Medical Expenses: the portion of the medical expenses that meet the scope of the basic medical insurance that exceeds 2,000 yuan in total during the year (January 1~December 31) of an active employee.
2. Settlement ratio: 50% reimbursement for the part of over 2,000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff is 20,000 yuan cumulatively in a year.
3. The insured personnel should keep the outpatient medical bills (including receipts and prescription bottoms, etc. for the parts below the large amount) of the outpatient consultation at the designated hospitals as the vouchers for reimbursement of medical expenses.
4, three kinds of special disease outpatient medical treatment: participants suffering from malignant tumors radiation therapy and chemotherapy, kidney dialysis, renal transplantation to take anti-rejection drugs need to be in outpatient medical treatment, by the participant's second and third-class hospitals for medical treatment of the designated hospitals to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the regional medical insurance center for approval and filing. The medical insurance center of the district for approval and filing.
The outpatient medical treatment for these three special diseases and the collection of medicines are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.
5. Inpatient medical care.
Medicare payment is enough for 20 years in order to enjoy the medical insurance reimbursement after retirement.
The range of reimbursement rates for medical insurance varies from place to place, so please refer to local policy regulations.
Baidu Encyclopedia - Medical Insurance