China's "Basic Medical Insurance Diagnostic and Treatment Program Catalog and Service Facility Program Catalog" has the following:
I. Diagnostic and Treatment Program Catalog of which the Basic Medical Insurance Fund does not pay for the costs
(A) Service Program Category
1, registration fee, out-of-hospital consultation fee, travel cost of the consulting medical staff, and cost of the medical record workbook.
2. Fees for special medical services such as consultation fees, expedited examination and treatment fees, surcharges for named surgeries, quality premium fees, fees for hiring special nurses, fees for special home visits, and fees for hiring specialists for consultation and treatment.
(2) Non-disease treatment program category
1, various types of cosmetic and body-building programs as well as non-functional cosmetic and orthopedic surgeries and physiological defects in the examination and treatment of the medical costs and personal use of orthopedic and body-building appliances.
(1) treatment of acne, freckles, acne scars, hyperpigmentation, dark spots;
(2) stuttering, snoring;
(3) hare lip, saddle nose;
(4) right eye, strabismus correction, single eyelid to double eyelid;
(5) mole removal, ear piercing, flat warts, armpit odor;
(6) skincare, face masks, inverted film;
(10) Walking aids, various kinds of therapeutic shoes;
(11) Costs of various kinds of home therapeutic instruments.
2. All costs of various weight loss, fat gain and height gain programs.
3, prevention, health care programs
(1) all kinds of health checkups, pre-marital checkups, outbound medical checkups and other costs;
(2) all kinds of costs of prevention. Including preventive medicine, preventive injections, disease screening and general treatment, social surveys, disease tracking, follow-up of various costs.
4, a variety of non-therapeutic counseling, appraisal costs
(1) psychological counseling (except for psychiatric medical counseling) fees, nutritional counseling fees, marriage and childbearing counseling fees, sexual counseling fees, health counseling fees;
(2) qigong fees, diet therapy fees, body therapy fees, a variety of health-care massage fees;
(3) stroke prediction, health forecasts, disease forecasts and other kinds of prediction fees;
(4) human body information diagnostic instrument pick-up fees, medicinal bath fees;
(5) judicial medical appraisal, medical malpractice appraisal, labor medical appraisal fees.
(3) diagnostic and therapeutic equipment and medical materials category
1, application of positron emission tomography device (PET), ultra-high-speed CT, ophthalmology excimer laser therapy device, stereotactic radiography device (α-knife, γ-knife) (treatment of diseases other than the central nervous system).
2. A variety of health care, massage, examination and treatment devices for self-use.
(1) magnetic therapy bra, magnetic therapy pants, magnetic therapy mattress, magnetic therapy undershirt, magnetic therapy shoes, magnetic therapy necklaces, etc.
(2) antihypertensive watches, pillows, cushions, etc.
(3) a variety of traction belts, crutches, etc.
(4) leather and steel undershirts, waistbands, testicular lifting belts, etc.
(5) gastric support, knee bands, steel head and neck, etc.
< p>(6) Kidney brace, uterus brace, scrotum brace, artificial anal bag.3, the province's price department regulations can not be charged separately disposable medical materials.
(D) therapeutic items category
1, all types of organ or tissue transplantation of organ source or tissue source.
2. Transplantation of organs or tissues other than kidney, heart valve, cornea, skin, blood vessel, bone and bone marrow transplantation.
3. Orthopedic surgery for myopia.
4. Music therapy, health care nutritional therapy.
5. Smoking cessation, drug treatment, all expenses for various teaching, research and clinical verification.
(5) Other
1, all kinds of infertility (pregnancy), sexual dysfunction examination, treatment costs, contraceptive devices and appliances costs.
2. Medical expenses for providing medical services for various meetings.
3. Costs of medicines used for environmental hygiene, summer cooling and preventive health care.
4, does not belong to the "Shandong Province, medical institutions fees and charges" within the scope of the diagnostic and treatment programs.
Two, the basic medical insurance fund to pay part of the cost of the scope of treatment items
(A) diagnostic and therapeutic equipment and medical materials
1, the application of X-ray computed tomography (CT), three-dimensional toward the radiographic device (у-knife, х-knife) (limited to the central nervous system). Knife) (limited to the treatment of central nervous system diseases), cardiac and angiographic X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MRI), single photon emission computerized scanning device (SPECT), color Doppler, medical linear gas pedal for examination, treatment projects.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy.
3, pacemaker, artificial joints, artificial crystals, artificial larynx, vascular stents (installation of the above imported artificial organs according to the highest price of similar types of domestic artificial organs).
4. Disposable medical materials that can be charged individually for more than 100 yuan as stipulated by the provincial price department.
(2) treatment program category
1, hemodialysis, peritoneal dialysis.
2, kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation.
3, heart laser perforation, anti-tumor cellular immunotherapy, microwave knife therapy, fast neutron therapy program.
(3) The use of network teleconsultation costs when eligible for referral.
(d) localities can be based on the actual situation of the local provisions of a certain price above the other use of special medical instruments and equipment for examination, testing, treatment, can be used as a basic medical insurance fund to pay part of the cost of treatment, should be reported at the same time to the Provincial Department of Labor and Social Security for the record.
Third, the basic medical insurance fund to pay for the cost of medical services and facilities range
1, general ward bed fee
2, outpatient (emergency) simple bed fee
Fourth, the basic medical insurance fund to pay for the cost of some of the medical services and facilities
1, guardianship wards (CCU, ICU)
2, laminar flow ward bed fee
2 Laminar flow ward bed fee
V. Scope of medical service facilities not covered by the basic medical insurance fund
1. Transportation fee for consultation (referral), emergency vehicle fee;
2. Air-conditioning fee, TV fee, heating fee, telephone fee, food warmer fee, maternal hygiene fee, electric stove fee, microwave oven fee, refrigerator fee, and compensation for damages to public property;
3.3, escort fee, nurse fee, cleaning fee, outpatient decoction fee, medicine guide fee, herbal medicine processing fee, corpse storage fee;
4, meal fee, nutritional fee;
5, books, newspapers, recreational activities, and other special needs living service fees.
Legal basis
Article 2 of the Social Insurance Law of the People's Republic of China stipulates that the State shall establish a social insurance system covering basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., and shall guarantee the right of citizens to receive material assistance from the State and the society according to the law in the event of old age, sickness, industrial injury, unemployment and childbirth. The right to material assistance from the State and society in the event of old age, sickness, industrial injury, unemployment or childbirth is guaranteed.
Article 26 of the Social Insurance Law of the People's Republic of China stipulates that the standards of treatment for basic medical insurance for workers, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with State regulations.
Article 28 of the Social Insurance Law of the People's Republic of China stipulates that medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, medical service facility standards, as well as those for emergencies and salvages, shall be paid out of the basic medical insurance fund in accordance with state regulations.