Interim Measures for the Management of Large Instrument Examinations and Special Treatments of Dalian Employees' Medical Insurance

Article 1 These measures are formulated in accordance with the Interim Provisions of Dalian Municipal Employees' Medical Insurance in order to strengthen the management of medical treatment and reduce waste. Article 2 These measures shall apply to the units and employees participating in medical insurance. Article 3 The large-scale instrument examination refers to: nuclear magnetic **** vibration (MRI), CT, ECT, color ultrasound diagnostic instrument examination (including one-time examination fee of more than 200 yuan for other examinations). Article 4 When an employee needs to have a large-scale instrument examination for medical treatment, the application shall be made by the attending physician, and the director or deputy director physician shall agree to and sign the application before it is carried out (emergency patients can be examined first, and the formalities shall be made up afterward). Article 5 The cost of large-scale instrument examination shall be borne by 30% of the active employees and 15% of the retirees, and the rest shall be paid by the medical insurance fund. The rest is paid by the medical insurance fund. Retirees of enterprises and retired old workers who joined the workforce before the founding of the PRC are fully covered by the medical insurance fund. Article 6 Special treatment refers to the treatment that requires special treatment methods due to the condition and incurs high medical expenses. They mainly include: organ transplantation, tissue transplantation, and installation of artificial organs. Article 7 When an employee needs organ or tissue transplantation (such as kidney transplantation, bone marrow transplantation, etc.) due to his/her medical condition, he/she shall be certified by the agreed medical institution and approved by the medical insurance administration organization. The costs of purchasing organs or tissues required, and the costs of anti-rejection drugs and immunomodulators used after discharge from the hospital shall be shared by the unit and the individual. Medical expenses in the process of transplantation shall be implemented in accordance with the Interim Provisions on Medical Insurance for Employees of Dalian City. Article 8 For the purchase of artificial organs (such as pacemakers, heart valves, artificial crystals, artificial larynx, artificial joints, etc.) due to the need of medical condition of the employees, upon the certificate issued by the agreed medical institution and the approval of the medical insurance organization, the medical insurance fund shall pay 50% of the cost of domestic artificial organs, and the medical insurance fund shall pay 35% of the cost of imported artificial organs, with the balance of the cost to be shared by the unit and the individual. The balance shall be shared by the unit and the individual. The medical expenses in the process of installing artificial organs shall be implemented in accordance with the Interim Provisions on Medical Insurance for Employees of Dalian City. Article 9 The costs of various special treatments involving the use of medicines other than those in the Scope of Payment and Non-payment of Dalian Employees' Medical Insurance Fees shall be shared by the unit and the individual. Article 10 The expenses stipulated in these Measures to be borne by individuals or shared by units and individuals shall not be paid from individual medical accounts, nor shall they be offset by the portion of the expenses borne by individuals as stipulated in the Interim Provisions of Dalian Municipal Employees' Medical Insurance. Article 11 These Measures shall be interpreted by the Dalian Municipal Health Bureau and the Dalian Municipal Labor Bureau in accordance with their respective responsibilities. Article XII of these measures shall come into force on July 1, 1996 .