The scope of reimbursement for medical insurance refers to the scope of reimbursement for standardizing basic medical insurance drugs, diagnosis and treatment items and medical service facilities (commonly known as "three catalogues") in order to protect the basic medical needs of the insured.
The medical insurance fund shall pay the related medical expenses incurred by the insured in the designated hospitals in accordance with the provisions of the three catalogues.
Reimbursement of urban medical insurance
Medical Insurance Reimbursement The scope of urban medical insurance reimbursement refers to all employers in cities and towns, as shown in the following figure:
1. Including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). );
2 organs, institutions, social organizations, private non-enterprise units and their employees shall participate in the basic medical insurance;
3. Some towns and villages stipulate that township enterprises and their employees, owners of urban individual economic organizations and their employees should be gradually incorporated into the basic medical insurance coverage (the last one depends on different local policies), so that they can enjoy medical reimbursement.
Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. And medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is relatively specific, with large project scale and coverage, but limited compensation for major diseases or accidents. At this point, the author suggests that the insured can purchase commercial supplementary medical insurance and social security to reduce their economic losses.
Employee medical insurance reimbursement
Medical insurance reimbursement
First, the basic insurance does not pay the cost of the scope of medical treatment projects.
(1) service items
1, registration fee, out-of-hospital consultation fee, medical record fee, etc.
2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for roll call operation, high quality and good price, and special care by oneself.
(2) Non-disease treatment projects
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects;
(3) Diagnostic equipment and medical materials.
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(4) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
Two, the basic medical insurance to pay part of the cost of diagnosis and treatment project scope