Rural Cooperative Medical Insurance
(1) Reimbursement Scope:
1. Pharmaceutical Fees: Auxiliary Examinations: Electrocardiograms, X-ray Fluoroscopy, Films, Laboratory Tests, Physiotherapy, Acupuncture, CT, Magnetic **** vibration and other examination fees are limited to 200 yuan; Surgical Fees (with reference to the national standard, more than 1000 yuan are reimbursed at 1000 yuan reimbursement).
2, the elderly over 60 years of age hospitalized in Xingta Town Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.
(2) Excluded from the scope of reimbursement:
1, self-medical treatment (without designated hospitals for medical treatment or without referral orders), self-purchased medicines, medicines not reimbursable under the provisions of public medical treatment and medical expenses not in line with family planning;
2, outpatient treatment, consultation fees, hospitalization, meals, accompanying guests, nutritional expenses, blood transfusion (except those with family blood storage, which are reimbursed according to the relevant regulations for reimbursement), air-conditioning and heating expenses, ambulance fees, special nursing fees and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, workplace accidents and medical malpractice;
4. Orthopedics, plastic surgery, dental implants, prosthetics, organ transplants, named surgery fees, consultation fees and other expenses;
5. Reimbursement of expenses within the scope of reimbursement, but not outside of the limit.
Employee medical insurance
Basic medical insurance to pay part of the cost of diagnosis and treatment items range
(a) diagnostic and treatment equipment and medical materials category
1, the application of X-ray computed tomography device (CT), stereotactic radiography device (γ-knife, χ-knife). -knife, χ-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler, medical linear gas pedal and other large-scale medical equipment for the examination and treatment of the project;
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2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3, pacemakers, artificial joints, artificial crystals, vascular stents in vivo replacement of artificial organs, in vivo placement of materials;
4, the provincial pricing department can be charged separately for disposable medical materials.
(B) treatment project category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplants;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
4, hearing aids and other rehabilitation appliances;
5, a variety of self-use health care, massage, check rehabilitation and treatment equipment.
(3) therapeutic items category
1, all kinds of organ transplants or tissue transplants of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplants other organs or tissue transplants;
3, orthopedics for myopia;
4, qigong therapy, music therapy, health care of the nutritional therapy, magnetic therapy and other complementary treatment programs.
(4) Others
1, various infertility (pregnancy), sexual dysfunction treatment programs;
2, various scientific research, clinical verification of treatment programs;
I. Scope of Treatment Programs Not Covered by the Basic Insurance Programs
(1) Service Programs
1, registration fees, out-of-hospital consultation fees, medical records, workbook fees, etc.;
2, medical records, medical records, medical records, medical records, etc., etc., etc., etc., etc., etc.
3, orthopaedic surgery;
4, qigong therapy, music therapy, health care nutrition therapy, magnetic therapy and other auxiliary treatment programs. Worker's fee, etc.
2. Special medical services such as consultation fee, expedited fee for examination and treatment (except for emergency), surcharge for surgery by name, high quality and premium fee, and fee for hiring special nurses on one's own.
(2) Non-disease treatment programs
1, various cosmetic (cosmetic life, medical cosmetology) fitness programs as well as messy non-functional plastic surgery, orthopedic surgery, etc.
2, various weight loss, weight gain, height increase programs;
3, various health checkups;
4, a variety of preventive, health care treatment programs; registration fees, consultation fees, medical records of workers' book fees. Consultation fee, medical record cost, etc.
5. Special medical services such as consultation fee, expedited examination and treatment fee (except for emergency), surcharge for named surgery, high quality and premium fee, and fee for hiring special nurses by oneself.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical aesthetics) fitness program and messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase in height projects;
3, a variety of health checkups;
4, a variety of preventive, health care treatment programs;
5, dental orthodontics, dental porcelain;
6, a variety of medical consultations (excluding psychiatric consultations), medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the examination and treatment of the project;
2, eyeglasses, dental prostheses, prosthetic eyes, prosthetic limbs, hearing aids, and other rehabilitation appliances;
3, all kinds of health care for their own use, massage, examination, rehabilitation and therapeutic instruments.
(4) therapeutic items category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation other organs or tissue transplantation;
3, myopic eye orthopaedics;
4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other supplementary treatment therapy, magnetic therapy and other complementary treatment programs.
(5) Other
1, various infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, various scientific research, clinical verification of diagnosis and treatment programs;
Urban medical insurance
Participants in the fixed-point medical institutions, the fixed-point retail pharmacies incurred the following projects Expenses are included in the reimbursement scope of the basic medical insurance fund for urban residents:
(a) medical expenses for hospitalization;
(b) medical expenses incurred within 7 days before the emergency detention and transfer to hospitalization;
(c) medical expenses in accordance with the provisions of the special outpatient medical category for urban residents;
(d) other expenses in accordance with the provisions.
The rest are not included in the scope of reimbursement.
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Expanded Information
Medicare
First of all, the difference between Medicare and non-Medicare drugs, the reimbursement threshold is also different according to the hospital level
Generally, Class A drugs can enjoy full reimbursement, Class C will need to be fully out-of-pocket expenses, while Class B reimbursement of 80%, the proportion of 20% out-of-pocket.
If a person uses 10,000 yuan in the hospital, if he or she is admitted to a first-class hospital, then 500 yuan will be subtracted first; if he or she is admitted to a second-class hospital, then 1,000 yuan will be subtracted first; if he or she is admitted to a third-class hospital, then 2,000 yuan will be subtracted first, which is a difference in the starting payment line.
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