For the workers our country stipulates that the employer needs to buy five insurance and one gold, one of the very important is the employee's medical insurance, the employee can be reimbursed for their own medical expenses within the scope of the provisions.
One, what is the employee health insurance
Employee health insurance is to compensate for the risk of disease suffered by workers and the establishment of a social insurance system. Through the employer and individual contributions, the establishment of medical +4 insurance fund, the insured person is sick to visit the medical expenses incurred with the medical insurance agency to give a certain amount of economic compensation, in order to avoid or alleviate the economic risks borne by the workers due to illness, treatment and so on.
Two, employee health insurance reimbursement program which
Basic medical insurance to pay part of the cost of diagnosis and treatment program scope:
(a) diagnostic and therapeutic equipment and medical materials category
1, the application of X-ray computed tomography (CT), stereotactic radiography (γ-knife, χ-knife), the stereotactic radiography (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 valve, cornea, skin, blood vessels, bone, bone marrow transplantation
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
(3) Examination and treatment items of medical instruments and equipment and medical materials with a single cost of more than $400.
Third, which does not belong to the employee health insurance reimbursement range
Basic insurance does not pay the cost of the range of diagnostic and treatment items:
(a) service category
1, registration fees, out-of-hospital consultation fees, medical records, such as the cost of work;
2, consultation fees, examination and treatment of expedited fees (except for emergencies), surcharge on the naming of the surgical procedures, quality premium fee, Special medical services such as self-invited special nurse fee.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness program as well as messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase the height of the project.
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 consultation (excluding psychiatric consultation), 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 inspection and treatment program
2, glasses, dentures, prosthetic eyes, prosthetics, hearing aids and other rehabilitative appliances.
3, a variety of self-use health care, massage, examination and rehabilitation and treatment equipment.
(D) therapeutic project 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 of other organs or tissues
3, myopic orthopaedics
4, qigong therapy, music therapy, health care nutritional therapy , magnetic therapy and other complementary therapeutic programs.
(E) other
1, a variety of infertility (pregnancy), sexual dysfunction treatment program
2, a variety of scientific research, clinical verification of the treatment program.
Legal Objective:The Social Insurance Law of the People's Republic of China
Article 28
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and salvages, shall be paid out of the basic medical insurance fund in accordance with state regulations.
The Social Insurance Law of the People's Republic of China
Article 29
The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administration agencies with the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.