Rizhao warm heart protection includes:
1. The medical expenses of medical insurance inpatients can be reimbursed by 80% after deducting 20,000 deductible lines, and the highest reimbursement can be1million;
2. After deducting the deductible of 20,000 yuan, the hospitalization medical expenses outside the medical insurance can be reimbursed by 60%, and the highest reimbursement can be100000;
3. For some high medical expenses and some rare diseases, you can enjoy the deductible line of 15000 yuan, and after deducting the deductible line, you can reimburse 60%, up to1000,000 yuan;
4. Some rare diseases can be reimbursed by 60% after deducting the deductible, with a maximum of 300,000 yuan.
Unpaid medical expenses:
1. Expenses not reimbursed according to the medical insurance policy for personal reasons.
2 should be paid from the industrial injury insurance fund and maternity insurance.
3. Expenses to be borne by the third party.
4. The expenses that should be borne by public health.
5. Medical expenses for going abroad, Hong Kong, Macao and Taiwan.
6. All kinds of infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects (such as male infertility and female infertility examination and treatment fees, all medical expenses in violation of the birth policy), as well as various teaching, scientific research and clinical verification diagnosis and treatment projects; Physical fitness, health care consumption, health check-up, premarital check-up, travel check-up, occupational check-up, exit check-up and other non-disease treatment items.
7. Drugs purchased without the prescription of designated experts.
8. Various medical appraisal fees (including but not limited to medical accident appraisal, psychiatric appraisal, pregnant woman's fetal sex appraisal, injury appraisal, paternity appraisal, genetic appraisal and other fees).
9. Medical expenses incurred during the period of stopping participating in the basic medical insurance for employees and residents in Rizhao City.
10. Various expenses such as cosmetic surgery, plastic surgery, non-functional orthopedic surgery, weight loss, freckle removal, mole removal, skin care, tooth implantation, tooth washing, glasses, artificial eyes, artificial limbs, hearing AIDS, etc. when the basic medical insurance for surgery or hospitalization is not reimbursed as a whole.
The following drugs will not be paid:
1. Health care drugs, vitamins and nutrients not included in medical insurance: adenosine triphosphate and its compound preparation, coenzyme A and its compound preparation, compound coenzyme A, energy mixture, rivanol, hydrolyzed fetal cell syrup, placental globulin, placental gamma protein and placental serum albumin.
2. Preventive vaccines and contraceptives.
3. Mainly used for treating alopecia, losing weight, beautifying, and quitting smoking and drinking.
4. The cost of plaster prescription and the following medicines and Chinese herbal pieces mainly used for nourishing and health care and containing national precious and endangered wild animals and plants is not included in the scope of "sunshine warm heart protection". Specifically, it includes donkey-hide gelatin, white sugar ginseng, Korean ginseng, pangolin (vinegar pangolin, pangolin), tortoise shell, Cordyceps sinensis, honey, dog treasure, tortoise plastron, oviductus Ranae, Syngnathus, hippocampus, monkey dates, wine-processed propolis, antelope horn tip powder (antelope horn pound tablets, antelope horn powder) and so on.
Note: The drugs listed above include raw medicinal materials and processed medicinal materials and decoction pieces.
4 laws, regulations, policies, documents and other expenses that are not paid according to the insurance clauses.