Employee medical insurance how to reimbursement, the scope of reimbursement? First, the basic medical insurance to pay part of the cost of diagnostic and treatment program scope (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), 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 accelerator and other large medical equipment ), color Doppler, medical linear gas pedal and other large medical equipment for examination, treatment projects; 2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy; 3, pacemakers, artificial joints, artificial crystals, vascular scaffolds in vivo replacement of artificial organs, in-vivo placement of materials; 4, the provincial price department can be charged individually for disposable medical materials. (B) treatment project category 1, hemodialysis, peritoneal dialysis; 2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation; 3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects. (3) Medical instruments and equipment for examination, treatment items and medical materials with a single cost of 400 yuan or more. Second, the scope of treatment items for which basic insurance does not cover the cost (a) service items 1, registration fee, out-of-hospital consultation fee, medical record cost, etc.; 2, consultation fee, examination and treatment expediting fee (except for emergency), surcharge for named surgery, quality premium fee, self-invited special nurse fee, and other special medical services. (B) non-disease treatment program category 1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness program and messy non-functional cosmetic surgery, orthopedic surgery, etc.; 2, a variety of weight loss, weight gain, height projects; 3, a variety of health checkups; 4, a variety of preventive, health care diagnosis and 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 treatment instrument and other large-scale medical equipment for the examination and treatment of the project; 2, eyeglasses, dental prostheses, eye prostheses, prosthetics, hearing aids and other rehabilitative appliances; 3, a variety of self-use of health care, massage, examination and rehabilitation and treatment of equipment. (D) Treatment 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 eye orthopedics; 4, qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other auxiliary treatment projects. (E) other 1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment projects; 2, a variety of scientific research, clinical verification of diagnosis and treatment projects;
Legal Objective:"Workers' Compensation Insurance Regulations," Article 17 of the accidental injury to employees or in accordance with the provisions of the law on the prevention and control of occupational diseases diagnosed and identified as occupational disease, the host unit shall be diagnosed within 30 days of the date of the accidental injury or identified as an occupational disease, appraised as an occupational disease within 30 days from the date of occurrence of the accidental injury or the date of diagnosis or appraisal as an occupational disease, the employer shall submit an application for the recognition of occupational injury to the social insurance administrative department of the co-ordinating region. In the event of special circumstances, the time limit for application may be appropriately extended with the consent of the social insurance administrative department. If the employer fails to submit an application for recognition of work injury in accordance with the provisions of the preceding paragraph, the injured employee, or his or her close relatives, or the trade union organization may, within one year from the date of occurrence of the accidental injury or from the date of diagnosis or appraisal of the injury as an occupational disease, directly submit an application for recognition of work injury to the administrative department of social insurance of the co-ordinated area where the employer is located. Matters that should be recognized as work-related injuries by the provincial social insurance administrative department in accordance with the provisions of Paragraph 1 of this Article shall be handled by the social insurance administrative department at the municipal level of the district where the employer is located in accordance with the principle of territoriality. If an employer fails to submit an application for work-related injury recognition within the time limit prescribed in Paragraph 1 of this Article, the expenses incurred during this period for treatment of work-related injuries in accordance with the provisions of these Regulations shall be borne by the employer. Article 18 of the application for recognition of work-related injuries shall be submitted to the following materials: (a) the application form for recognition of work-related injuries; (b) and the employer of the existence of labor relations (including de facto labor relations) of the documents; (c) medical diagnosis or diagnosis of occupational diseases or diagnosis of occupational diseases (or diagnosis of occupational diseases). The application form for the determination of work injury shall include the time, place and cause of the accident as well as the basic information such as the degree of injury of the employee. If the materials provided by the applicant for the determination of work-related injuries are incomplete, the social insurance administrative department shall inform the applicant in writing of all the materials that need to be corrected. The applicant in accordance with the written notice of the requirement to correct the material, the social insurance administrative department shall accept.