General hospitalization required drugs, as long as listed in the medical insurance catalog can be reimbursed, not listed in the medical insurance catalog of drugs can not be reimbursed for the time being.
2. Auxiliary examination fees:
Examination fees in medical institutions can be reimbursed, such as electrocardiogram, X-ray fluoroscopy, filming, laboratory tests, physical therapy, nuclear magnetic **** vibration and other examination fees.
3. Outpatient and emergency expenses:
In each medical insurance year, outpatient and emergency expenses exceeding 2,000 yuan in total can be reimbursed at a rate of 50 percent.
I. Scope of medical treatment items for which basic insurance does not cover expenses
(1) Service item category
1, registration fee, out-of-hospital consultation fee, and medical record cost;
2, consultation fee, expedited fee for checkups and treatments (except for emergencies), surcharge on named surgeries, high-quality and high-quality price, and fee for self-employed special nurses and other specially needed medical services.
(2) Non-disease treatment programs
1, various cosmetic (cosmetic life, medical cosmetology) fitness programs as well as messy non-functional plastic surgery, orthopedic surgery, etc.
2, various weight loss, weight gain, height increase programs;
3, various health checkups;
4, a variety of preventive, health care treatment programs; registration fees, consultation fees, medical records of workers' book fees. Consultation fee, medical record cost, etc.
5. Special medical services such as consultation fee, expedited examination and treatment fee (except for emergency), surcharge for named surgery, high quality and premium fee, and fee for hiring special nurses by oneself.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical aesthetics) fitness program and messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, gain weight, increase in height projects;
3, a variety of health checkups;
4, a variety of preventive, health care clinic program;
5, dental orthodontics, dental porcelain;
6, a variety of medical consultations (excluding psychiatric consultations), medical appraisal.
(C) diagnostic and therapeutic equipment and medical materials category
1, the application of positron emission tomography device, electron beam
CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the examination and treatment program;
2, glasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids, and other rehabilitation appliances;
3, all kinds of self-use health care, Massage, examination and rehabilitation and treatment instruments.
(4) therapeutic items category
1, all kinds of organ transplantation or tissue transplantation of organ or tissue source;
2, in addition to kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissues;
3, myopic orthopaedic surgery;
4, qigong therapy, music therapy, health care of nutrition therapy, magnetic therapy and other complementary therapeutic therapy, magnetic therapy and other complementary treatment programs.
(5) Others
1, various infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, various scientific research, clinical verification of diagnosis and treatment programs; urban health insurance participants in designated medical institutions, designated retail pharmacies, the following items are included in the reimbursement of urban residents' basic medical insurance fund:
(1) (a) medical expenses for hospitalization;
(b) medical expenses incurred within 7 days before being transferred to inpatient treatment in case of emergency;
(c) medical expenses in accordance with the regulations on special outpatient diseases for urban residents;
(d) other expenses in accordance with the regulations. The rest are not included in the scope of reimbursement.
Legal Basis
The Social Insurance Law of the People's Republic of China
Article 30
The following medical expenses shall not be 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 paid by a third person;
(4) other expenses that are not specified. person;
(iii) should be borne by the public ****health;
(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 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 making the payment first.
Article 28
Medical expenses in accordance with the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with national regulations.