(1) Reimbursement scope:
1, drug cost: auxiliary examination: 200 yuan for ECG, X-ray fluoroscopy, photography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
2. The elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
(2) Not covered by reimbursement:
1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;
2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;
4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;
5, within the scope of reimbursement, beyond the limit.
Employee medical insurance
The scope of the basic medical insurance to pay part of the cost of diagnosis and treatment projects.
(a) diagnosis and treatment equipment and medical materials
1, using X-ray computed tomography (CT), stereotactic radiotherapy device (γ knife, χ knife), cardiac and angiographic X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3. Pacemakers, artificial joints, intraocular lenses, vascular stents, etc. replace artificial organs in vivo and place materials in vivo;
4, the provisions of the provincial price department can be charged separately for disposable medical materials.
(2) Treatment items
1, hemodialysis, peritoneal dialysis;
2. Transplantation of kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow;
3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.
4, hearing AIDS and other rehabilitation equipment;
5, all kinds of personal health care, massage, rehabilitation and treatment equipment.
(3) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(4) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
First, the basic insurance does not pay the cost of the scope of medical treatment projects.
(1) service items
1, registration fee, out-of-hospital consultation fee, medical record fee, etc.
2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and special care by oneself.
(2) Non-disease treatment projects
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects; Registration fee, out-of-hospital consultation fee, medical record fee, etc. ;
5. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for name calling operation, high quality and good price, and special care by oneself.
(2) Non-disease treatment projects
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects;
5, tooth deformity, dental porcelain;
6, all kinds of medical consultation (excluding psychiatric consultation), medical appraisal.
(3) Diagnostic equipment and medical materials.
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(4) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
Urban medical insurance
The following expenses incurred by the insured in designated medical institutions and retail pharmacies are included in the reimbursement scope of the basic medical insurance fund for urban residents:
(a) hospitalization expenses;
(two) medical expenses within 7 days before emergency observation and hospitalization;
(three) the medical expenses for special diseases in urban residents' outpatient clinics;
(4) Other expenses that meet the requirements.
The rest are not included in the scope of reimbursement.
Extended data
medical insurance
First of all, the difference between medical insurance drugs and non-medical insurance drugs, reimbursement deductible line is also different according to hospital level.
Generally, Class A drugs can enjoy full coverage, while Class C drugs need to bear all the expenses, while Class B drugs will be charged 80% and bear 20% of the expenses.
A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible.
References:
Scope of medical insurance reimbursement-Baidu Encyclopedia