Not covered by the national health insurance.
The scope of treatment items for which fees are not payable
(I) Service item category
1, registration fee, out-of-hospital consultation fee, medical record cost, etc.
2, consultation fee, expedited fee for examination and treatment (except for emergencies), surcharge on surgery by name, high quality and premium fee, self-invited special nurses' fee, and other special medical services.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetic) fitness program and messy non-functional plastic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase the height of the project.
3, a variety of health checkups.
4, a variety of preventive, health care treatment programs.
5, dental orthodontics, dental porcelain.
6, a variety of medical consultation (excluding psychiatric consultation), medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the inspection and treatment program
2, glasses, dentures, prosthetic eyes, prosthetics, hearing aids and other rehabilitative appliances.
3, a variety of self-use health care, massage, examination and rehabilitation and treatment equipment.
(D) therapeutic project category
1, all kinds of organ transplantation or tissue transplantation of organ source 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 orthopaedics
4, qigong therapy, music therapy, health care nutritional therapy , magnetic therapy and other complementary therapeutic programs.
(E) Other
1, a variety of infertility (pregnancy), sexual dysfunction treatment program
2, a variety of scientific research, clinical verification of the treatment program.
Expanded Information:
p>I. Reimbursement conditions
Article 28 of the Social Insurance Law stipulates that medical expenses in accordance with the basic medical insurance drug list, diagnostic and treatment items, medical service facility standards, as well as emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
According to the basic requirements for the payment of basic medical insurance benefits in China, the reimbursement of medical expenses incurred by the insured person to the medical insurance organization for his/her own visit to the doctor generally has to comply with the following conditions:
(1) The insured person must go to the designated medical institutions for the purchase of medicines of the basic medical insurance or go to the designated retail pharmacies determined by the social insurance organization with the medicine prescription issued by the doctor of the designated hospital. The purchase of medicines.
(2) Medical expenses incurred by insured persons in the course of seeking medical treatment must be in accordance with the scope and payment standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, in order to be paid by the basic medical insurance fund in accordance with the regulations.
(3) The portion of medical expenses incurred by a participant in accordance with the scope of payment of basic medical insurance that are above the starting standard and below the maximum payment limit of the social medical insurance fund shall be paid by the social medical insurance fund in a uniform proportion.
2. Reimbursement Ratio
1. Outpatient and emergency medical expenses: the portion of medical expenses that meet the scope of the basic medical insurance within the year (January 1~December 31) of an active employee that exceeds 2,000 yuan in total.
2. Settlement ratio: 50% reimbursement for the part of over 2,000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff is 20,000 yuan cumulatively in a year.
3. The insured personnel should keep the outpatient medical bills (including receipts and prescription bottoms, etc. for the part of the outpatient medical bills below the large amount) of the designated hospitals as the vouchers for reimbursement of medical expenses.
4, three kinds of special disease outpatient medical treatment: participants suffering from malignant tumors radiation therapy and chemotherapy, kidney dialysis, renal transplantation to take anti-rejection drugs need to be in outpatient medical treatment, by the participant's second and third-class hospitals for medical treatment of the designated hospitals to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the regional medical insurance center for approval and filing. The medical insurance center of the district for approval and filing.
The outpatient medical treatment for these three special diseases and the collection of medicines are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.
5. Inpatient medical care.
Medicare payment is enough for 20 years in order to enjoy the medical insurance reimbursement after retirement.
The range of reimbursement rates for medical insurance varies from place to place, so please refer to local policy regulations.
Baidu Encyclopedia-Medical Insurance