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Medical insurance reimbursement scope in 2016
One, the starting standard of major medical insurance for employees
Saigon medical insurance for chronic diseases, special diseases, major diseases, the annual starting standard is 700 yuan. Category A, as well as general medical treatment needs to pay 80%, 75% of Category B is 70% for highly sophisticated.
The maximum payment limit is 50,000 yuan. This includes hospitalization, outpatient chronic diseases, special diseases, major diseases.
Three, diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser treatment instrument and other large medical equipment for examination and treatment items;
2, glasses, denture, prosthetic eye, prosthetic limbs, hearing aids and other rehabilitative appliances;
3, all kinds of self-use health care, massage
4, the provincial price department regulations can not be charged separately disposable medical.
Four, treatment items
1, all kinds of organ or tissue transplantation of organ or tissue source;
2, in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation of other organs or tissues;
3, myopic eye orthopedic surgery;
4, qigong therapy, music therapy, health care of the nutritional therapy, magnetic therapy and other complementary treatment programs.
5, other categories
1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, a variety of scientific research, clinical verification of diagnosis and treatment programs.
2. Items not reimbursed by medical insurance
Services
1, registration fee, out-of-hospital consultation fee, and cost of medical records;
2, consultation fee, expedited fee for examination and treatment, surcharge for surgery by name, high quality premium fee, and special medical services such as hiring special nurses.
Non-disease treatment programs
1, a variety of cosmetic, bodybuilding and non-functional plastic surgery, orthopedic surgery, etc.
2, a variety of weight loss, weight gain, height projects;
3, a variety of health checkups;
4, a variety of preventive, health care diagnostic and treatment programs;
5, a variety of medical consulting, medical appraisal.
Employee health insurance reimbursement process in 2016
One, the employee hospitalization reimbursement process
First of all, you need to show your health insurance card, and then pay the fee according to the hospital's regulations, and then you can go to the hospital's medical insurance office to settle the bill after you are discharged from the hospital and then you will be able to enjoy the health insurance treatment.
The process of reimbursement for hospitalization in other places
(1) Declaration and settlement information
Please bring the following information for reimbursement for hospitalization in other places
1, invoice of hospitalization billing (with seal)
2, detailed list of hospitalization expenses (with seal)
3, record of hospitalization (with seal)
4, copy of voluntary certificate of use of medicines other than those in the catalog and special diagnostic and treatment items. Voluntary copy of special diagnostic and therapeutic items (stamped)
5, medical insurance card
6, complete procedures "** City ** District urban workers' medical insurance referral form"
(2), Settlement
Offsite hospitalization procedures are complete, five working days after the receipt of vouchers, My ID card (on behalf of the person who needs to provide the ID card of the person on behalf of the person) to settle the reimbursement. Reimbursement will be suspended from the 28th to the end of each month and resumed from the first day of the following month.
Third, outpatient reimbursement procedures for patients with serious illnesses
1. Reimbursement time
High blood pressure and diabetes outpatient reimbursement of patients with serious illnesses: the first quarter of March; the second quarter of June; the third quarter of September; the fourth quarter of December.
Reimbursement for outpatient critically ill patients with other conditions is made monthly.
2. Reporting and Settlement Documents
1) Outpatient medical receipts;
2) Chinese prescriptions delineated and stamped;
3) Examinations accompanied by the original examination report form.
3. Settlement
The reimbursement amount will be directly transferred to the bank passbook of the person concerned after 5 working days after the formalities are completed.