Reimbursement of Rizhao Nuanxinbao
1, medical insurance hospitalization/outpatient medical security
The insured amount 1 10,000, after deducting the deductible of 20,000, will be reimbursed by 80%.
2. Out-of-hospital medical insurance
The deductible is 20,000 yuan. After being reimbursed by social security, it will be paid at 60%, with a maximum reimbursement of 6,543,800 yuan.
3, the specific medicine has high safety.
The insured amount of 1 10,000 yuan can be reimbursed up to 60%, and some designated drugs for rare diseases can enjoy the deductible of10.5 million yuan.
4, some rare diseases designated drug protection
The maximum reimbursement for the insured amount of 300,000 yuan is 60%, and the deductible of10.5 million yuan can be enjoyed with some high-priced drugs.
Reimbursement data
1. "Expenses for chronic diseases and special diseases in inpatient and outpatient departments within the overall scope of basic medical insurance" and "Expenses for hospitalization outside the overall scope of basic medical insurance" reimbursement materials:
There is no need to provide reimbursement materials for local medical treatment in Rizhao city. The following reimbursement materials are required for medical treatment in different places:
(1) Copy of the insured's ID card;
② Bank account of the insured or beneficiary (card number, bank and mobile phone number);
2. Reimbursement materials for "specified high drug expenses" and "specified drugs (special food) expenses for some rare diseases":
(1) Identity certificates of the applicant and the insured;
② Bank account of the insured or beneficiary;
(3) List of drug expenses and receipts or invoices issued by medical institutions;
(4) Specialized prescription;
⑤ Pathological diagnosis report (provided only when applying for reimbursement for the first time);
⑥ Hospitalization record/discharge summary (hospitalization record includes medical record home page, admission record, discharge summary, image inspection report, etc.). );
⑦ Immunohistochemical/genetic test report (provided as appropriate, optional).
List of medical expenses that Rizhao Warm Heart Insurance will not pay.
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 a doctor's prescription.
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.
1 1. Organ source or tissue source of various organ or tissue transplants and related expenses (including but not limited to storage expenses, transportation expenses, etc. ).
13. Other expenses not paid according to laws, regulations, policies, documents and insurance clauses.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.