(a) Clinical treatment is necessary for safe and effective diagnosis and treatment projects, the cost is appropriate;
(b) by the price department has set the charges for the diagnosis and treatment projects;
(c) provided by designated (C) by the fixed-point medical institutions for the insured to provide fixed-point medical services within the scope of the diagnostic and treatment items. Fourth, the basic medical insurance scope and catalog of diagnostic and treatment items adhere to the basic needs of clinical diagnosis and treatment, taking into account the city's economic situation and the differences in medical technology level of the principle of scientific and reasonable, convenient management. V. Basic medical insurance does not pay the cost of the scope of diagnosis and treatment items:
(A) service items:
1. not included in the "Xi'an City, urban workers' basic medical insurance inpatient hospitalization catalog" and "Interim Provisions on the Management of the Scope of Special Diseases" of the diagnosis and treatment of the disease;
2. registration fee, out-of-hospital consultation fees, medical records, fees, consultation fees;
3. 3. Non-medical special nursing fee, examination and treatment expediting fee, name surgery surcharge, quality premium fee.
(2) non-disease treatment programs:
1. beauty, fitness programs and non-functional cosmetic and orthopedic surgery;
2. weight loss, weight gain, height increase programs;
3. health checkups, forecasting: finger pulse instrument, meridian diagnostic instrument, microcirculation checker and other costs;
4. prevention, health care treatment programs: health massage Health care and medical treatment programs: health care massage fee, medicinal bath fee, automatic massage bed treatment fee, drug steam room treatment fee, human body information diagnostic instrument examination fee;
5. All kinds of medical consulting, medical appraisal, medical research fees, stroke prediction, health prediction, disease prediction, judicial appraisal fee, labor appraisal fee;
6. Smoking cessation, drug addiction treatment fee;
7. Medical expenses for fights and assaults, alcoholism, suicide, self-injury, traffic accidents and medical accidents.
(C) diagnostic and therapeutic equipment and medical materials:
1. application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy instrument;
2. eyeglasses, dental prostheses, eye prostheses, prostheses, hearing aids and other rehabilitative appliances;
3. all kinds of health care for their own use, massage, checking and diagnostic equipment: pillows, cushions, pumps, hot packs and so on.
4. In addition to syringes, infusion sets, blood transfusion, domestic ordinary catheters other than disposable materials and provincial and municipal pricing departments can not be charged separately for disposable medical materials.
(D) treatment program category:
1. All kinds of organ or tissue transplantation of organs or tissue sources;
2. In addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation (such as the heart, liver, lungs and other organs transplantation);
3. Orthopaedic myopic eyes, a variety of physiological defects of the surgery, dental cleaning, Dental veneers, orthopedics for irregular teeth, treatment of stained teeth, dental orthodontics, dental porcelain;
4. Qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic programs.
(E) Other
1. Various infertility (pregnancy), sexual dysfunction treatment programs;
2. Various scientific research, clinical verification of the treatment program. Sixth, the basic medical insurance to pay part of the cost of treatment program scope:
(A) diagnostic and treatment equipment and medical materials:
1. Application of X-ray computed tomography (CT), stereotactic emission device (γ-knife, χ-knife), cardiac and Angiography χ line machine (including digital subtraction equipment), magnetic *** vibration imaging device (MBI), single photon emission computer scanning device (SPECT), color Doppler, medical linear gas pedal and other large-scale medical equipment costing more than 150 yuan for examination, treatment projects, the cost of which the individual to bear 30%, the overall fund to bear 70%; but there is a clear diagnosis, the person himself However, if a clear diagnosis has been made and the individual requests a repeat examination, the cost will be borne by the individual. In accordance with the regulations of the Ministry of Health, the results of special examinations are subject to the control of a positive rate indicator, which is regularly announced. The costs of special examinations that do not meet the target are borne by the medical institutions (positive rate: CT≥75%, ECT>75%, MRI>70%).
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen chamber treatment and other treatment programs that cost more than 50% more than conventional treatment, the cost of which will be borne by the individual 30%, 70% of the overall fund; conventional treatment techniques can be cured, but I asked for the use of high-tech equipment, the cost of the treatment will be borne by the individual.
3. 30% of the cost of installing domestic universal artificial organs (heart valves, artificial crystals, artificial larynx and artificial hip joints), vascular stents, materials to be placed in the body, pacemakers, and the cost of purchasing organs and materials shall be borne by the individuals themselves, and 70% shall be borne by the Comprehensive Fund; 30% of the cost of carrying out surgeries for transplantation of organs and tissues of the human body shall be borne by the individuals themselves, and 70% shall be borne by the Comprehensive Fund.
4. For disposable medical materials that can be charged separately as stipulated by the provincial and municipal price departments (list), the cost shall be borne by the individual 30% and the comprehensive fund 70%.
(2) therapeutic projects:
1. hemodialysis, peritoneal dialysis;
2. kidney, heart valve, cornea, blood vessel, bone marrow transplantation;
3. cardiac laser perforation, anti-tumor cellular immunotherapy, and fast neutron therapy projects.
The cost of treatment for the above programs shall be borne by the individual at 30% and the Comprehensive Fund at 70%.
(3) For the cost of expensive medical instruments and equipment, examination and treatment items and medical materials as stipulated by the Provincial Department of Labor, the individual's self-payment ratio shall refer to the self-payment ratio of the similar items mentioned above.
(4) For outpatient dialysis for patients with chronic renal failure, outpatient anti-rejection drugs for kidney transplant patients, and outpatient radiotherapy and chemotherapy for cancer patients, with the certificate of diagnosis of the disease issued by the designated medical institution and the original medical record, and with the approval of the medical insurance agency, the patient shall first pay the cash in advance, and then reimburse to the medical insurance agency with the valid bill and the approval procedure, and the individual shall bear 30% and the integrated fund shall bear 70% of the expenses. The medical insurance agency will reimburse the patient with 30% of the cost to the individual and 70% of the cost to the fund.