General hospitalization required drugs, as long as listed in the medical insurance directory can be reimbursed, not listed in the medical insurance directory 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, the portion of outpatient and emergency expenses exceeding 2,000 yuan in total can be reimbursed at a rate of 50 percent.
The scope of reimbursement for inpatient medical insurance is as follows:
1, medicine, auxiliary examination, EKG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT, MR*** vibration, and other examination fees are limited to 200 yuan;
2, surgical fees (with reference to the national standard, reimbursement for more than 1,000 yuan is made according to the amount of 1,000 yuan).
An elderly person aged 60 years or above who is hospitalized at the health center, the treatment fee and nursing fee will be reimbursed at a rate of 50%. Hospitalization, treatment and nursing fees are reimbursed at 10 yuan per day, with a limit of 200 yuan;
3. Reimbursement ratio: 60% for town health centers; 40% for secondary hospitals; 30% for tertiary hospitals;
4. Major diseases. Where to participate in the cooperative medical treatment of hospitalized patients one-time or annual cumulative reportable medical expenses exceeding 5,000 yuan of segmented compensation, that is, 5,001-10,000 yuan reimbursement of 65%, 10,001-18,000 yuan reimbursement of 70%. Township-level cooperative medical inpatient and uremia outpatient blood dialysis, outpatient radiotherapy and chemotherapy oncology compensation annual limit of 1. 10,000 yuan;
5, exemption. Self-medical treatment (without designated hospitals for medical treatment or without a referral order), self-purchased medicines, medicines that cannot be reimbursed under the public medical care regulations and medical expenses not in accordance with family planning; outpatient treatment fees, consultation fees, hospitalization fees, meals, companion fees, nutritional fees, blood transfusion (except for those who have a family blood bank, which is reimbursed in accordance with the relevant regulations), heating and cooling, ambulance fees, special care and other expenses; car accidents, fights, suicides, Alcoholism, workplace accidents and medical malpractice; orthopedics, plastic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, etc.; reimbursement within the scope of reimbursement, part of the limit outside.
I. Scope of treatment items not covered by basic insurance
(1) Service items
1, registration fee, out-of-hospital consultation fee, and cost of medical records;
2, consultation fee, expedited fee for checkups and treatments (except for emergencies), surcharge on named surgeries, high quality premium fee, and fee for special nurses for special needs 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.
Summary of the above is the editor of the hospitalization medical insurance reimbursement is which to make the relevant answer, I hope to help you
Legal basis:
"Chinese people*** and the State Social Insurance Law," Article 29
Part of the medical costs of the insured person should be paid for by the basic medical insurance fund by the social insurance agency and the medical institutions, drug business units for direct settlement.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Article 7
The social insurance administrative department of the State Council shall be responsible for the administration of social insurance throughout the country, and other relevant departments of the State Council shall be responsible for relevant social insurance work within their respective areas of responsibility.
The social insurance administrative departments of the local people's governments at or above the county level are responsible for the administration of social insurance in their own administrative areas, and other relevant departments of the local people's governments at or above the county level are responsible for the relevant social insurance work within their respective areas of responsibility.