2, drug costs (the scope of drug use in accordance with the provincial drug catalog);
3, examination fees (inspection, laboratory tests, etc., up to a limit of 600 yuan);
4, treatment costs (up to 300 yuan to settle the bill on a case-by-case basis, and the part above 300 yuan to be included in the reimbursement scope at 50%);
5, surgical fees (according to the prescribed fee);
5, surgical fees (up to 300 yuan to be included in the reimbursement scope at 50%); and Above part of 50% into the scope of reimbursement);
5, surgical fees (in accordance with the prescribed fees);
6, blood transfusion costs (surgery or rescue, each hospitalization up to a maximum limit of 500 yuan);
7, materials (each hospitalization up to a maximum limit of 2,000 yuan);
8, a variety of oncology patients with radiotherapy, chemotherapy, and renal failure requiring Outpatient expenses for dialysis are reimbursed as if they were hospitalized.
Ratio of reimbursement:
After eliminating non-reimbursable expenses, the reimbursable expenses are discounted according to the level of the medical institutions: 100% for township health centers in the city, 90% for municipal hospitals in the city, 80% for hospitals outside the city, and 60% for those without referral certificates. The discounted fees are settled proportionally by sections: 45% for up to RMB 4,000; 55% for RMB 4,001-8,000; 65% for RMB 8,001-12,000; 75% for RMB 12,001-20,000; and 80% for more than RMB 20,000. The maximum amount of reimbursement per person per year is not more than 30,000 yuan.
Medical expense reimbursement requires materials, formalities and procedures:
(1) The required materials are:
1, the original hospitalization invoice;
2, discharge records;
3, the list of medical expenses or medical orders (provided by the hospitals);
4, proof of identity (copy of the ID card or proof of household registration);
5, other documents (such as the medical certificate);
5, the medical certificate;
5, the medical certificate;
5, the medical certificate. p>
5, other (referral certificate, proof of part-time job, etc.).
(2) procedures and procedures
Patients in the city, directly in the designated medical institutions to settle hospitalization costs; transfer of hospitalization costs outside the city, within one month will be the above materials to the township health hospitals (co-management of the Office of the operator for the settlement of formalities, after the first examination, the townships centralized to send to the municipal health insurance office to settle the bill.
Medicare reimbursement for non-disease treatment items include:
1, all kinds of cosmetic and plastic surgery programs: such as acne, scar cosmetic, laser cosmetic, cosmetic dental cleaning, hair transplantation and so on.
2. Orthopedic treatment items: stuttering, irregular teeth, denture repair (including piled crowns, set of crowns, mounted denture), dental implants, snoring surgery (except for respiratory distress), flat feet and other items (except for congenital strabismus, cleft lip and palate, and post-polio sequelae).
3, a variety of bodybuilding treatment programs: such as weight loss, fat gain, height, etc..
4, a variety of health check-up programs: such as employee physical examination, disease census.
5, a variety of prevention, health care treatment programs: such as a variety of vaccination, fitness, etc..
6, a variety of medical consultation, health forecasting and treatment programs: such as a variety of disease consultation fees (except for psychological counseling carried out by the second and third-level mental health prevention and treatment institutions), finger pulse instrument, microcirculation checker, meridian diagnostic instrument (including traditional Chinese medicine computerized diagnostic instrument), the life of information diagnostic and treatment instrument.
7, a variety of medical appraisal projects: such as labor capacity appraisal (employee labor, industrial injury, occupational disease diagnosis and appraisal), the judicial appraisal of mental patients, medical malpractice appraisal, a variety of injury examination fees.
Legal basis
The People's Republic of China Social Insurance Law
Article 28 meets the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.
Article 30 The following medical expenses shall not be included in the scope of payment of 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;
(4) those who seek medical treatment outside China.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person 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.