According to the scope of reimbursement of medical insurance, the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy, human body information diagnostic equipment and other examination and treatment items are not reimbursable. Therefore, if the insured person only took the film and was not hospitalized, the social security can not be reimbursed for the related costs.
In addition, the social security system is unable to reimburse the medical expenses caused by various factors, such as the registration fee, cosmetic surgery, organ transplantation, and fighting. Participants must pay attention.
One, the scope of medical insurance is not reimbursed:
The basic medical insurance for employees will not pay for the cost of diagnostic and treatment items are mainly non-clinical necessity, the effect of uncertainty of diagnostic and treatment items and diagnostic and treatment items of the special medical services, including services such as registration fees, non-disease treatment items such as cosmetic surgery, therapeutic equipment and medical materials such as hearing aids, therapeutic items such as magnetism, and other categories such as infertility treatment. and other categories such as infertility treatment.
In accordance with the National Basic Medical Insurance Scope of Treatment Programs, the details are as follows:
1. Services: registration fees, out-of-hospital consultation fees, medical records, etc.; visit fees, expedited fees for examination and treatment, surcharges for named surgeries, quality and premium fees, special nurses and other special medical services;
2. Non-disease treatments: a variety of cosmetic, fitness items and And non-functional cosmetic, orthopedic surgery, etc.; a variety of weight loss, weight gain, height projects; a variety of health checkups; a variety of preventive, health care diagnostic and treatment programs; a variety of medical consultation, medical appraisal;
Diagnostic and treatment equipment and medical materials: application of positron emission tomography, electron beam cT, ophthalmology, excimer laser therapy instrument and other large-scale medical equipment for examination, treatment programs; eyeglasses, Prosthetic teeth, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitative appliances; a variety of self-use health care, massage, examination and treatment equipment; provincial price departments can not be charged separately for disposable medical;
3, treatment projects: all types of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation, other organs or tissues transplantation; myopia Orthopedic surgery; qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic programs;
4. Other: a variety of infertility (pregnancy), sexual dysfunction of the diagnosis and treatment program; a variety of scientific research, clinical validation of the diagnostic and treatment programs.
Legal basis:
The People's Republic of China Social Insurance Law
Article 30 The following medical expenses are not included in the scope of payment by the basic medical insurance fund:
(1) Those that should be paid from the Workers' Compensation Insurance Fund;
(2) Those that should be borne by a third party;
(3) Those that should be borne by a third party;
(4) Other: various kinds of fertility (pregnancy) disorders; various kinds of scientific research, clinical verification of medical treatment.
(iii) should be borne by the public ****health;
(iv) medical treatment outside the country.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after making the payment
.
The Ministry of Labor and Social Security, the Ministry of Finance, the State Economic and Trade Commission, the Ministry of Health, the State Administration of Traditional Chinese Medicine on the issuance of the strengthening of the basic medical insurance for urban workers, the scope of medical treatment items, medical services and facilities, and the payment standards of the opinion of the Notice
I. The scope of the basic medical insurance does not pay for the cost of medical treatment items
(a) the category of the service items
1. Registration fee, out-of-hospital consultation fee, and medical record cost.
2. Special medical services such as visit fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, and self-invited special nurse.
(2) Non-disease treatment programs
1. Various cosmetic and body-building programs as well as non-functional cosmetic and orthopedic surgeries.
2. All kinds of weight loss, fat gain, height increase program.
3. All kinds of health checkups.
4. A variety of preventive, health care treatment programs.
5. All kinds of medical consultation, medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1. Application of positron emission tomography bag device (PET), electron-beam CT, ophthalmic excimer laser treatment device and other large-scale medical equipment for the examination and treatment program.
2. Eyeglasses, dentures, eye prostheses, prosthetics, hearing aids and other rehabilitative devices.
3. All kinds of self-use health care, massage, examination and treatment equipment.
4. Provincial pricing departments can not be charged separately for disposable medical materials.
(D) therapeutic projects
1. Organ or tissue transplantation of all types of organ or tissue source.
2. Transplantation of organs or tissues other than kidney, heart valve, cornea, skin, blood vessel, bone and bone marrow transplantation.
3. Orthopedic surgery for myopia.
4. Complementary therapeutic programs such as qigong therapy, music therapy, nutrient therapy for health care, and magnetic therapy.
(E) other
1. A variety of infertility (pregnancy), sexual dysfunction treatment program.
2. A variety of scientific research, clinical verification of the diagnostic and treatment programs.