What expenses can be reported for hospitalization medical insurance?

Employee medical insurance reimbursement scope

1, kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow transplantation

2, the application of X-ray computed tomography (CT), stereotactic radiotherapy device (γ knife, χ knife), heart and angiography X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (MEI), single photon emission computer scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment for examination and treatment projects.

3. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;

4, cardiac pacemakers, artificial joints, intraocular lenses, vascular stents and other in vivo replacement of artificial organs, in vivo placement materials;

5, the provisions of the provincial price department can be charged separately for disposable medical materials.

Treatment item category

6. Hemodialysis and peritoneal dialysis;

7. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.

Hearing AIDS and other rehabilitation equipment;

8, all kinds of personal health care, massage, rehabilitation and treatment equipment.

9, all kinds of infertility (pregnancy), sexual dysfunction diagnosis and treatment projects;

10, various scientific research and clinical verification diagnosis and treatment projects;

The scope of reimbursement of hospitalization compensation for rural medical insurance:

1, drug cost: auxiliary examination: 200 yuan for ECG, X-ray fluoroscopy, photography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

2, the elderly over 60 years old in hospital, treatment and nursing expenses daily compensation 10 yuan, the limit of 200 yuan.

(2) Reimbursement ratio:

60% reimbursement for town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

legal ground

People's Republic of China (PRC) social insurance law

Article 24 The state establishes and improves the new rural cooperative medical system.

Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.