The scope of medical insurance reimbursement for hospitalization surgeries is as follows:
1. Hospitalization fees;
2. Costs of using hospital equipment;
3. Surgery expenses;
4. Medical expenses, etc. Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses can be reimbursed.
The documents required for reimbursement are as follows:
1. The documents required for outpatient reimbursement are outpatient invoices and cooperative medical certificates (or medical records);
2. Hospitalization The materials carried for reimbursement include hospitalization invoices, cooperative medical certificates (or medical records), detailed expense lists, discharge summaries, and other relevant certificates;
3. The materials carried for reimbursement of outpatient special diseases include outpatient invoices, special diseases Cooperative Medical Care Certificate Calendar;
4. The documents to be carried when applying for special diseases are outpatient treatment recommendations for special diseases, Cooperative Medical Care Certificate Calendar, medical records, relevant laboratory reports, and two photos.
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
1. They should be paid from the work-related injury insurance fund;
2. They should be paid by a third party
3. Should be borne by the public health department;
4. Those seeking medical treatment abroad. Medical expenses shall be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.
Legal basis:
Article 28 of the "Social Insurance Law of the People's Republic of China"
In line with the basic medical insurance drug catalog, diagnosis and treatment items, Standards of medical service facilities and medical expenses for emergency and rescue services shall be paid from the basic medical insurance fund in accordance with national regulations.