1. Scope of diagnosis and treatment items not covered by basic medical insurance: organ sources or tissues of various organ or tissue transplants; Various beauty and bodybuilding projects and non-functional beauty and plastic surgery; Orthopedic surgery for myopia;
2, the basic medical insurance to pay part of the cost of diagnosis and treatment project scope: pacemaker, artificial joint, intraocular lens, vascular stent and other artificial organs in vivo replacement, in vivo placement of materials; Kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow transplantation; Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects; Hemodialysis and peritoneal dialysis;
3. Normal insurance coverage of basic medical insurance: In addition to the scope of medical treatment items that do not pay the fees and the scope of medical treatment items that pay part of the fees, according to the Document Opinions of the Ministry of Labor and Social Security, the State Planning Commission, the Ministry of Finance, the Ministry of Health and state administration of traditional chinese medicine on Determining the Scope of Medical Service Facilities and Payment Standards of Basic Medical Insurance for Urban Employees.
Measures of Shanghai Municipality on Settlement of Basic Medical Insurance for Urban and Rural Residents Article 15 (Accounting and Payment of Medical Expenses) The medical expenses incurred by the insured in the designated medical institutions of medical insurance in this Municipality shall be accounted by the designated medical institutions of medical insurance for urban and rural residents and paid by the medical insurance fund for urban and rural residents according to regulations.
Legal basis:
Measures for Settlement of Basic Medical Insurance for Urban and Rural Residents in Shanghai (II) Settlement of medical expenses for observation in inpatient or emergency observation room.
1. The medical expenses incurred by the insured in the hospital or emergency observation room belong to the expenses paid by the urban and rural residents' medical insurance fund, which shall be accounted for by the designated medical institutions, and the rest shall be borne by individuals. Accounting medical expenses shall be settled by designated medical institutions to the local county-level medical insurance center; The rest of the medical expenses are collected from the insured by the designated medical institutions.
2 college students in the city to implement designated medical care (except emergency hospitalization), designated hospitals by colleges and universities in the city's basic medical insurance designated medical institutions within the scope of reasonable determination. If the college students are hospitalized, the department designated by the college will issue the Settlement Voucher of Shanghai Urban and Rural Residents' Basic Medical Insurance (for college students) (see Annex 1).