1, drugs, consumables, etc. , does not belong to the basic drug list of medical insurance, and exceeds the limit of drug costs;
2. Items outside the medical insurance catalogue, such as cosmetic surgery, unnecessary physical examination, health care products, etc.
3, illegal medical behavior, illegal medical institutions to provide medical services;
4. Non-essential hospital bed fees, such as single rooms and luxury suites;
5. Medical expenses paid by individuals at their own expense, such as voluntarily choosing high-end medical services and purchasing medical equipment at their own expense;
6, the new rural cooperative medical care costs outside the prescribed scope, such as going abroad for medical treatment, do not calculate my actual hospitalization expenses.
Specific provisions on the use of the new rural cooperative medical system:
1. Participants: The participants of the new rural cooperative medical system are rural residents, including farmers, rural laborers and laid-off workers in cities and towns.
2. Payment standard: The payment standard of the new rural cooperative medical system is jointly formulated by the central and local governments, generally calculated according to the per capita payment standard, and the payment standard may be different in different regions.
3. Reimbursement ratio: The reimbursement ratio of the new rural cooperative medical system is generally 60% to 80%, which may be different according to different medical projects and regional policies.
4. Reimbursement scope: The reimbursement scope of the new rural cooperative medical system includes outpatient service, hospitalization, essential drugs, serious illness insurance and other medical items, but the specific scope is also different due to different regional policies and medical items, which need to be judged according to local policies and regulations.
5. Reimbursement restrictions: The new rural cooperative medical system has certain restrictions on the reimbursement of medical items. For some high-cost medical items, it is necessary to provide corresponding medical proof materials, otherwise it may not be reimbursed.
To sum up, the specific use of the new rural cooperative medical system needs to be judged according to local policies and systems. If in doubt, you can consult the local new rural cooperative medical management institution. At the same time, the insured also need to provide true and accurate materials and medical certificates when using the new rural cooperative medical system to avoid violations or false reimbursement.
Legal basis:
Article 30 of People's Republic of China (PRC) Social Insurance Law
The following medical expenses are not included in the basic medical insurance fund payment scope.
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.