Legal analysis: Medical Insurance Center:
Because I need to be hospitalized for a certain disease, how many days of treatment in a certain hospital will cost how much yuan, I purchased medical insurance, now Apply to the Social Security Center for review and reimbursement.
I hereby apply
Applicant:
Application time: year month day
Medical insurance is to compensate for medical treatment caused by diseases A type of insurance for expenses. Social insurance that provides necessary medical services or material assistance to employees due to illness, injury, or childbirth, provided by the society or the enterprise. Among them, medical expenses are various expenses incurred by patients for treatment. They include not only doctors’ medical expenses and surgical fees, but also the expenses for hospitalization, nursing care, hospital equipment, etc.
Medical insurance will not pay. The fees mainly include the following categories:
1. Service items.
(1) Registration fee and medical record cost.
(2) Special services such as consultation fees, house call fees (including home hospital bed inspection fees), expedited examination and treatment fees, roll-call surgery surcharges, high-quality and low-price fees, escort fees, self-recruited special nurse fees, etc. cost.
2. Non-disease treatment items.
(1) The cost of various beauty and bodybuilding projects as well as some non-functional plastic surgery and orthopedic surgeries.
(2) Various weight loss, weight gain and height gain projects.
(3) Various health examinations.
(4) Various preventive and health-care diagnosis and treatment projects.
(5) Various medical consultation and medical appraisal projects.
3. Medical materials.
(1) Rehabilitation equipment such as glasses, dentures, eyes, prostheses, and hearing aids.
(2) Various self-use health care, massage, examination and treatment equipment.
(3) Imbedded automatic cardioverter defibrillator (ICD).
(4) Disposable medical materials that are not chargeable separately according to provincial and municipal price department regulations.
4. Diagnostic and treatment equipment.
Examination and treatment projects using large-scale medical equipment such as positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy equipment.
5. Treatment items.
(1) Organ sources or tissue sources for various types of organ or tissue transplantation.
(2) Other organ transplants or tissue transplants except kidney, heart valve, cornea, skin, blood vessel, bone, and bone marrow transplant.
(3) Myopia orthopedic surgery.
(4) Qigong therapy, music therapy (except for mental patients), health nutrition therapy, magnet therapy and other auxiliary treatment projects.
6. Others.
(1) Diagnosis and treatment items for various infertility (fertility) diseases and sexual dysfunction.
(2) Various scientific research and clinically verified diagnosis and treatment projects.
(3) All expenses incurred due to fights, fights, alcoholism, traffic accidents, medical accidents, injury liability accidents, and intentional self-injury.
(4) Medical expenses incurred while going abroad, visiting relatives, attending meetings, inspections, further studies, and giving lectures in Hong Kong, Macao, and Taiwan.
(5) Except for emergencies and first aid, diagnosis and treatment items beyond the scope of registered diagnosis and treatment subjects performed by designated medical institutions.
(6) Diagnosis and treatment projects for external cooperation with designated medical institutions.
(7) Diagnosis and treatment items that are not included in the medical service charging standards stipulated by the provincial and municipal price departments.
In many places, when medical insurance centers reimburse medical expenses, it is not required at all
Legal basis: Article 28 of the "Social Insurance Law" complies with the basic medical insurance drug catalog, diagnosis and treatment items , medical service facility standards and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29 of the "Social Insurance Law" The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.
The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.