Rural Cooperative Medical Insurance

(1) Reimbursement scope:

1. Medication expenses: auxiliary examinations: electrocardiogram, X-ray, film, The fee limit for various examinations such as laboratory tests, physical therapy, acupuncture, CT, MRI, etc. is 200 yuan; the operation fee (referring to the national standard, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).

2. For elderly people over 60 years old who are hospitalized in Xingta Town Health Center, treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.

(2) Not included in the scope of reimbursement:

1. Self-seeking medical treatment (seeking medical treatment without a designated hospital or not applying for a referral), self-purchased drugs, and drugs that cannot be reimbursed under public medical regulations and medical expenses that are not in compliance with family planning;

2. Outpatient treatment fees, consultation fees, hospitalization fees, meals, companionship fees, nutrition fees, and blood transfusion fees (except for those with family blood storage, according to relevant regulations reimbursement), heating and cooling fees, ambulance fees, special care fees and other expenses;

3. Medical expenses for car accidents, fights, suicide, alcoholism, work-related accidents and medical accidents;

4. Orthopedics, plastic surgery, dentures, prostheses, organ transplants, surgical fees, consultation fees, etc.;

5. Within the scope of reimbursement, the portion beyond the limit.

Employee medical insurance

The scope of medical treatment items for which basic medical insurance pays part of the cost

(1) Diagnostic and treatment equipment and medical materials

1. Apply X-ray computed tomography equipment (CT), stereotactic radiation equipment (γ-knife, χ-knife), cardiac and angiography X-ray machines (including digital subtraction equipment), and magnetic resonance imaging Inspection and treatment projects for large-scale medical equipment such as MEI, single-photon emission electronic scanning equipment (SPECT), color Doppler, and medical linear accelerator;

2. Extracorporeal shock wave lithotripsy and Hyperbaric oxygen therapy;

3. Pacemakers, artificial joints, intraocular lenses, artificial organs for internal replacement of vascular stents, and materials placed in the body;

4. Provincial price department regulations of disposable medical materials that can be charged separately.

(2) Treatment items

1. Hemodialysis, peritoneal dialysis;

2. Kidneys, heart valves, cornea, skin, blood vessels, bones, Bone marrow transplantation;

3. Heart laser drilling, anti-tumor cell immunotherapy and fast neutron therapy projects.

4. Hearing aids and other rehabilitation equipment;

5. Various self-use health care, massage, examination, rehabilitation and treatment equipment.

(3) Treatment Items

1. Organ sources or tissue sources for various organ transplants or tissue transplants;

2. Except for kidneys and heart valves , cornea, skin, blood vessels, bones, bone marrow transplants and other organ or tissue transplants;

3. Orthopedics for myopia;

4. Qigong therapy, music therapy, health care Nutritional therapy, magnetic therapy and other auxiliary treatment projects.

(4) Others

1. Diagnosis and treatment items for various infertility (pregnancy) diseases and sexual dysfunction;

2. Various scientific research, Clinically verified diagnosis and treatment items;

1. Scope of diagnosis and treatment items that are not covered by basic insurance

(1) Service items

1. Registration fee , out-of-hospital consultation fees, medical record costs, etc.;

2. Consultation fees, expedited examination and treatment fees (except emergency), roll-call surgery surcharges, high-quality and low-price fees, self-recruitment special nurse fees and other special medical needs Serve.

(2) Non-disease treatment items

1. Various beauty (life beauty, medical beauty) and bodybuilding projects as well as non-functional plastic surgery, orthopedic surgery, etc.;

2. Various weight loss, fattening and heightening programs;

3. Various health examinations;

4. Various preventive and health-care diagnosis and treatment programs; registration Fees, out-of-hospital consultation fees, medical record costs, etc.;

5. Consultation fees, expedited examination and treatment fees (except emergency), roll-call surgery surcharges, high-quality and low-price fees, self-recruitment special nurse fees and other special needs Medical services.

(2) Non-disease treatment items

1. Various beauty (life beauty, medical beauty) and bodybuilding projects as well as non-functional plastic surgery, orthopedic surgery, etc.;

2. Various weight loss, fattening, and height-increasing programs;

3. Various health examinations;

4. Various preventive and health-care diagnosis and treatment programs; < /p>

5. Orthodontics, dental porcelain;

6. Various medical consultations (excluding psychiatric consultations) and medical appraisals.

(3) Diagnostic and treatment equipment and medical materials

1. Use large-scale medical equipment such as positron emission tomography equipment, electron beam CT, ophthalmic excimer laser therapy equipment for examination and treatment Projects;

2. Rehabilitation equipment such as glasses, dentures, eyes, prostheses, and hearing aids;

3. Various self-use health care, massage, examination, rehabilitation and treatment equipment.

(4) Treatment Items

1. Organ sources or tissue sources for various organ transplants or tissue transplants;

2. Except for kidneys and heart valves , cornea, skin, blood vessels, bones, bone marrow transplants and other organ or tissue transplants;

3. Orthopedics for myopia;

4. Qigong therapy, music therapy, health care Nutritional therapy, magnetic therapy and other auxiliary treatment projects.

(5) Others

1. Various diagnosis and treatment items for infertility (pregnancy) and sexual dysfunction;

2. Various scientific research, Clinically verified diagnosis and treatment items;

Urban Medical Insurance

The following expenses incurred by insured persons at designated medical institutions and designated retail pharmacies are included in the reimbursement scope of the Urban Resident Basic Medical Insurance Fund:

(1) Medical expenses for hospitalization;

(2) Medical expenses within 7 days before emergency stay for observation and transfer to hospitalization;

(3) ) Medical expenses that comply with the regulations on special diseases for urban residents;

(4) Other expenses that comply with the regulations.

Anything else not specified will not be included in the scope of reimbursement.

/iknow-pic.cdn.bcebos.com/6a600c338744ebf8e43c1131d4f9d72a6059a76b"target="_blank"title=""class="ikqb_img_alink">/iknow-pic.cdn.bcebos.com/6a600c338744ebf8e43c1 131d4f9d72a6059a76b?x- bce-process=image%2Fresize%2Cm_lfit%2Cw_600%2Ch_800%2Climit_1%2Fquality%2Cq_85%2Fformat%2Cf_auto"esrc="/6a600c338744ebf8e43c1131d4f9d72a6059a76b"/>

Extended information

medical insurance

First of all, there is a difference between medical insurance drugs and non-medical insurance drugs. The reimbursement threshold is also different according to the hospital level.

Generally, Class A drugs can enjoy full reimbursement, while Class C drugs need to be fully paid out of pocket. , while Category B reports 80% and is responsible for 20%.

Suppose a person spent 10,000 yuan in the hospital. If he was treated in a first-level hospital, then 500 yuan would be deducted first; if he was treated in a second-level hospital, then 1,000 yuan would be deducted first; If you are hospitalized in a tertiary hospital, 2,000 yuan will be deducted first. This is the difference in the deductible.

Reference:/baike.baidu.com/item/%E5%8C%BB%E4%BF%9D%E6%8A%A5%E9%94%80%E8%8C%83% E5%9B%B4/17657520?fr=aladdin"target="_blank"title="Scope of medical insurance reimbursement--Baidu Encyclopedia">Scope of medical insurance reimbursement--Baidu Encyclopedia