1, outpatient and emergency medical expenses: the medical expenses that meet the requirements of basic medical insurance in the year (11October1February 31February) exceeded 2,000 yuan.
2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.
3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.
4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.
5. Hospitalization.
After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.
6 cases of outpatient medical insurance in Dalian are not reimbursed.
1, medical expenses beyond the scope of medical insurance payment;
2, the use of medical insurance to pay for drugs and medical services within the scope of the project, should be borne by individuals in proportion to the cost;
3, the insured during hospitalization (including family beds) outpatient medical expenses;
4, the insured units or individuals in arrears of basic medical insurance premiums (including premiums) during the medical expenses;
5, the insured is not in the provisions of the outpatient co-ordination of designated medical institutions for medical expenses;
6 other expenses that do not meet the requirements of the basic medical insurance.
Dalian medical insurance cannot reimburse hospitalization expenses.
(1) service item classification. Registration fee and medical record fee; Consultation fee, house call fee, urgent fee for examination and treatment, additional fee for name-calling operation, high-quality and good-price fee, escort fee, self-invited special care and other special service fees.
(2) Non-disease treatment projects. Expenses for various beauty and bodybuilding projects and some non-functional beauty and plastic surgery; All kinds of weight loss, weight gain and height increase projects; Various health checks; Various preventive health care diagnosis and treatment projects; Various medical consultation and medical appraisal projects.
(3) Medical materials. Rehabilitation appliances such as glasses, dentures, artificial eyes, artificial limbs and hearing AIDS; All kinds of self-use health care, massage, examination and treatment equipment; Implantable automatic cardioversion defibrillator (ICD); Disposable medical materials that cannot be charged separately as stipulated by the provincial and municipal price departments.
(4) diagnosis and treatment equipment. Large-scale medical equipment such as positron emission tomography (PET), electron beam CT and ophthalmic excimer laser therapeutic apparatus are used for examination and treatment.
(5) Treatment items. The organ source or tissue source of various organ or tissue transplants; Organ transplantation or tissue transplantation other than kidney, liver transplantation, heart valve, cornea, skin, blood vessels, bone and bone marrow transplantation; Orthopedic surgery for myopia; Qigong therapy, music therapy (except mental patients), health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(6) others. Pregnancy, abortion, all kinds of infertility (fertility), sexual dysfunction diagnosis and treatment projects; Various scientific research and clinical verification diagnosis and treatment projects; All expenses incurred due to fighting, fighting, drug abuse, alcoholism, traffic accidents, medical accidents, injury liability accidents, intentional self-injury and suicide; Medical expenses incurred during going abroad and going to Hong Kong, Macao and Taiwan for treatment, visiting relatives, meetings, inspections, further studies and lectures.
(seven) foreign cooperation in diagnosis and treatment projects; Items that are not included in the medical insurance diagnosis and treatment project and those that are not priced by the provincial price department are tentatively defined as items that are not paid by the basic medical insurance.
(8) Other circumstances in which the expenses stipulated in the national, provincial and municipal basic medical insurance policies for urban residents are not paid.
Reimbursement conditions of Dalian medical insurance
Outpatient reimbursement conditions:
1, all enterprises, institutions, social organizations, private non-enterprise units, individual industrial and commercial households with employees and their employees and retirees within the administrative area of Dalian;
2. Individual industrial and commercial households and freelancers with urban household registration in Dalian and no employees within the working age range;
3. Retirees who have urban household registration in Dalian, receive basic old-age insurance as flexible employees, and have paid basic medical insurance premiums for employees according to regulations.
4. The insured person has obtained the designated qualification of medical insurance in the designated medical institution of 103, and has the conditions for outpatient operation.
Conditions for hospitalization reimbursement:
1, urban workers, urban and rural residents and other insured objects.
2. See a doctor in a medical institution that has obtained the designated qualification for medical insurance and has the conditions for outpatient surgery.
Proportion of medical insurance reimbursement in Dalian
Outpatient medical expenses:
Minimum payment standard: not set.
Reimbursement ratio
Local medical treatment for Dalian insured: 45% reimbursement.
Dalian insured person seeking medical treatment in different places: 30% reimbursement
In addition, the highest quarterly reimbursement can be 180 yuan.