List of reimbursement scope and proportion of urban medical insurance in Guangzhou. The following is a list of the scope and proportion of urban medical insurance reimbursement in Guangzhou. I hope the following information can help your life.
Guangzhou urban medical insurance reimbursement scope:
According to the regulations, the reimbursement scope of medical insurance shall conform to the national regulations on the scope of medical insurance drugs, diagnosis and treatment items, medical service facilities, payment standards and basic medical insurance. Municipal labor and social security administrative department
The door can also be adjusted according to the level of economic development and the actual situation of this Municipality, and implemented after being approved by the Municipal People's government.
Payment scope of personal medical account
1, basic medical expenses for outpatient common diseases and emergency;
2, hospitalization, outpatient specific projects and designated chronic diseases should be borne by the individual basic medical expenses;
3, holding a prescription to the designated retail pharmacies, or the cost of purchasing over-the-counter drugs;
4, other expenses stipulated by the national and provincial medical insurance policies.
The scope of reimbursement for specific outpatient items
1, stay in the emergency observation room of the second-and third-level designated medical institutions for observation and treatment;
2, in one or two designated medical institutions or designated community health service institutions to open a family bed for treatment;
3, suffering from malignant tumor in the designated medical institutions for outpatient chemotherapy, radiotherapy and adjuvant therapy;
4, suffering from uremia in designated medical institutions for outpatient dialysis treatment;
5. After kidney transplantation in designated medical institutions, continue to receive anti-rejection treatment in outpatient clinics of designated medical institutions;
6, suffering from hemophilia in tertiary comprehensive designated medical institutions for outpatient treatment.
The scope of diagnosis and treatment items covered by the third-class medical insurance.
First, diagnosis and treatment equipment and medical materials
1, using X-ray computed tomography (CT), stereotactic radiation device (V knife, X knife), cardiac and angiographic X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (MRI), single photon emission computer scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy.
List of compensation standards:
3, pacemakers, artificial joints, intraocular lenses, vascular stents and other artificial organs in vivo substitutes, in vivo placement materials.
4, the provisions of the provincial price department can be charged separately for disposable medical materials.
Second, the treatment project
1, hemodialysis, peritoneal dialysis.
2, kidney, heart valve, cornea, skin, blood vessels, bones, bone marrow transplantation.
3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Three, the provisions of the provincial labor and social security departments of expensive medical equipment inspection, treatment projects and medical materials.
Provisions on reimbursement of sporadic medical expenses
Under normal circumstances, the insured person should seek medical treatment in the designated medical institutions of social insurance in Guangzhou, and the expenses paid by the fund should be settled directly in the designated medical institutions without going through the reimbursement procedures. The basic medical expenses incurred in the following circumstances can be reimbursed for sporadic medical expenses in the nearest medical insurance agency in our city:
1, the basic medical expenses that meet the scope of medical treatment in different places;
2. Due to objective reasons such as retrospective treatment and invalidation of medical insurance system. Basic medical expenses that cannot be settled in designated medical institutions;
3, the insured emergency or rescue due to illness, as well as the special needs of treatment due to illness, approved by the municipal medical insurance agencies, in the city as a whole area of non designated medical institutions hospitalization or emergency hospitalization observation of basic medical expenses;
4, in line with other special circumstances stipulated in the medical insurance policy.