(1). Registration fee, medical record cost.
(2). Consultation fee, consultation fee (including home bed rounds fee), examination and treatment expediting fee, surcharge for named surgery, quality premium fee, escort fee, self-invited special nurse fee and other special service fees.
2. Non-disease treatment program category.
(1). Costs of various beauty and fitness programs and some non-functional cosmetic and orthopedic surgeries.
(2). Various weight loss, fat gain and height gain programs.
(3). Various health checkups.
(4). Various preventive and health care treatment programs.
(5). Various medical consultation and medical appraisal programs.
3. Medical materials.
(1). Eyeglasses, denture, eye prosthesis, prosthetic limbs, hearing aids and other rehabilitative devices.
(2). All kinds of self-use health care, massage, examination and treatment instruments.
(3). Buried automatic defibrillator (ICD).
(4). Provincial and municipal price department regulations can not be charged separately disposable medical materials.
4. Diagnostic equipment category.
Application of positron emission tomography device (PET), electron beam CT, ophthalmic excimer laser treatment device and other large-scale medical equipment for examination and treatment programs.
5. Treatment program category.
(1). Organ source or tissue source for all types of organ or tissue transplantation.
(2). Organ transplants or tissue transplants other than kidney, heart valve, cornea, skin, blood vessel, bone, and bone marrow transplants.
(3). Orthopedic surgery for myopia.
(4). Complementary therapeutic programs such as qigong therapy, music therapy (except for psychiatric patients), health care nutritional therapy, and magnetic therapy.
6. Others.
(1). A variety of infertility (fertility), sexual dysfunction diagnosis and treatment program.
(2). A variety of scientific research, clinical verification of the diagnosis and treatment program.
(3). All expenses incurred due to fighting, assault, alcoholism, traffic accidents, medical malpractice, injury liability accidents, intentional self-inflicted injuries and self-inflicted injuries.
(4). Medical expenses incurred during the period of going abroad and traveling to Hong Kong, Macao and Taiwan for family visits, meetings, study tours, further training and lectures.
(5). Except for emergency and first aid, the treatment items conducted by the designated medical institutions that are beyond the scope of the registered treatment subjects.
(6). The treatment programs of the designated medical institutions in cooperation with foreign countries.
(7). Not included in the provincial and municipal pricing departments of the medical services fees standard diagnostic and therapeutic items.
I. What are non-medicare medicines and why are they not compensated
Non-medicare medicines refer to medicines that are not listed in the medicare medicines catalog, that is, medicines that are not reimbursed by the medical insurance.
II. Determination of the main body of responsibility for non-medicare drugs
The purpose of the creation of compulsory insurance and commercial third party insurance is to ensure that the victim can get compensation in a timely manner, in the case of the victim or his close relatives can not decide whether or not to be treated in accordance with the provisions of the basic medical insurance, the tortfeasor and the insurance company should bear the responsibility. However, in reality, it is difficult to determine whether the tortfeasor or the insurance company is responsible for the situation.
Three. Determination of the validity of the non-medical drugs exemption clause in the insurance contract
In reality, in order to avoid the embarrassment of non-medical drugs, the insurance company will often be agreed in the insurance contract, "non-medical drugs do not pay" this exemption clause. This clause has always been a controversial part of the trial of traffic accident claims. If the party providing the format clause exempts its responsibility, aggravates the responsibility of the other party, or excludes the main rights of the other party, the clause is invalid", the insurance company has not proved that it has already fulfilled its obligation of informing the insured clearly, the part of the clause is obviously invalid. Of course, in order to avoid the difficulty of proof, the insurance company will usually print, copy or audio-video recording of the exemption clause to ensure the fulfillment of the obligation to inform, but according to the principle of relativity of contract, the effect of the insurance clause only applies to both parties to the contract. Since this clause concerns the interests of an unspecified victim, the victim is not involved in the conclusion of the contract. According to the basic principles of civil law, without the consent of the third party entitled to the interests of the two parties to the contract can not be outside the contract of the legal interests of the third party to make restrictions. Therefore, in the case of traffic collision claims, the clause often can not have an adverse effect on the victim. Therefore, even if the exemption clause exists, it can not exempt the insurance company to the victim to bear the responsibility of non-medical drug benefits.
Legal Basis
The People's Republic of China Social Insurance Law
Article 30: The following medical expenses are not included in the scope of payment by the basic medical insurance fund:
(1) Those that should be paid from the Workers' Compensation Insurance Fund;
(2) Those that should be borne by a third party;
(3) Those that should be borne by the public***health insurance fund;
(3) Those that should be borne by the public health insurance fund;
All of these expenses are not included in the scope of payment by the basic medical insurance fund. burden;
(iv) medical treatment outside the country.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.