Two, the basic medical insurance to pay part of the cost of diagnosis and treatment program scope
1, diagnostic and treatment equipment and medical materials category
(1) the application of X-ray computed tomography (CT), stereotactic radiography device (γ-knife, χ-knife) , cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single photon emission computer scanning device (SPECT), color Doppler, medical linear gas pedal and other large-scale medical equipment for the examination and treatment of the project;
(2) extracorporeal shockwave lithotripsy and hyperbaric oxygen therapy;
(3) cardiac pacemakers, Artificial joints, artificial crystals, vascular stents in vivo replacement of artificial organs, in vivo placement of materials;
(4) Provincial pricing department of the disposable medical materials that can be charged separately.
2, treatment program 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 program.
Hearing aids and other rehabilitation appliances;
(4) A variety of self-use health care, massage, examination rehabilitation and treatment equipment.
3, other
(1) a variety of infertility (pregnancy), sexual dysfunction treatment program;
(2) a variety of scientific research, clinical validation of the treatment program.
Three, medical insurance reimbursement ratio
1, outpatient, emergency medical expenses: within one consecutive year the employee's such expenses in line with the scope of medical insurance requirements of the medical expenses reached a total of 2,000 yuan or more part of;
2, the settlement ratio: the contract period of the dispatched personnel to reach the 2,000 yuan or more part of the reimbursement of 50%, the individual to bear the remaining 50%; in the consecutive year Accumulated outpatient and emergency reimbursement for dispatched personnel is up to 20,000 yuan;
3. The insured personnel must keep the medical bills of the designated medical institutions as the vouchers for reimbursement;
4. Outpatient medical treatment for three kinds of special illnesses: when the insured personnel need outpatient medical treatment for radiation therapy and chemotherapy for malignant tumors, kidney dialysis, or anti-rejection drugs after kidney transplantation, the insured personnel must ask the hospital to issue a certificate issued by the hospital for the treatment of the malignant tumors. The hospital issued by the "disease diagnosis certificate", and fill out the "medical insurance special disease declaration and approval form", reported to the local health insurance center for approval and filing. These three special diseases must be diagnosed and treated in the designated hospitals before settlement.
Legal basis:
The Social Insurance Law of the People's Republic of China
Article 2: The State establishes a social insurance system for basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, and maternity insurance, and guarantees the right of citizens to obtain material assistance from the State and society according to the law in the event of old age, sickness, industrial injury, unemployment, or maternity. and society in the event of old age, sickness, industrial injury, unemployment or maternity, in accordance with the law.
Article 26: The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State.
Article 28 Medical expenses that conform to the basic medical insurance drug list, diagnostic and therapeutic items, and standards of medical service facilities, as well as those for emergencies and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers
Article 28 The individual account shall be used to pay for medical expenses beyond the scope of payment by the integrated fund; any shortfall in payment by the individual account shall be borne by the individual himself/herself.
Article 47 The charges for basic medical services shall be formulated and revised by the provincial labor security and price administration departments in conjunction with the health administration and finance departments, and reported to the provincial government for approval. The price of basic medical insurance drugs shall be in accordance with national regulations on drug pricing. Violation of the basic medical service program fee standards and drug prices, the basic medical insurance fund accounts do not pay for over-standard medical fees.