2. Drug expenses (the scope of drug use shall be subject to the provisions of the provincial drug catalogue);
3, inspection fees (inspection, testing, etc. , limit 600 yuan);
4. Treatment expenses (settled according to the facts within 300 yuan, and 50% of the above parts in 300 yuan are included in the scope of reimbursement);
5. Surgery fee (charged according to regulations);
6. Blood transfusion fee (the maximum amount of surgery or rescue and hospitalization is in 500 yuan);
7, material costs (the maximum limit of 2000 yuan per hospitalization);
8, all kinds of tumor patients with radiotherapy, chemotherapy and renal failure need dialysis outpatient expenses, as hospitalization expenses for compensation.
Reimbursement ratio:
After excluding non-reimbursable expenses, the reportable expenses are discounted according to different levels of medical institutions: township hospitals in this city 100%, municipal hospitals in this city 90%, outside the city 80%, and 60% without referral certificate. After the discount, the expenses will be settled in proportion: 45% will be reimbursed within 4000 yuan; 400 1-8000 yuan will be reimbursed by 55%; 800 1- 12000 yuan will be reimbursed by 65%; 12001-20,000 yuan will be reimbursed by 75%; More than 20 thousand yuan will be reimbursed 80%. The maximum amount of compensation per person per year shall not exceed 30,000 yuan.
Materials, procedures and processes required for reimbursement of medical expenses:
(a) the required materials are:
1, original hospitalization invoice;
2. Discharge record;
3, medical expenses list or doctor's advice (provided by the hospital);
4. My identity certificate (copy of ID card or household registration certificate);
5. Others (recommendation certificate, work place certificate, etc.). ).
(2) Procedures and formalities
Patients hospitalized in this city shall directly settle hospitalization expenses in designated medical institutions; For the hospitalization expenses transferred from outside the city, 1 month, the above materials shall be submitted to the handling personnel of township hospitals (joint management office) for settlement, and then sent to the municipal medical insurance office for settlement after preliminary examination.
Non-disease treatment items for medical insurance reimbursement include:
1, various cosmetic plastic surgery projects: such as acne, scar cosmetic, laser cosmetic, cosmetic tooth washing, hair transplant, etc.
2. Orthopedic treatment items: stuttering, dentition disorder, denture restoration (including post crown, crown fitting, denture installation), dental implantation, nasal snoring surgery (except respiratory distress), flat feet and other items (except congenital torticollis, cleft lip and palate, sequelae of polio).
3. Various bodybuilding treatment items: such as losing weight, gaining weight and increasing height.
4. Various physical examination items: such as employee physical examination and disease investigation.
5. Various preventive and health care projects: such as vaccination and fitness.
6. Various medical consultation and health prediction diagnosis and treatment items: such as various disease consultation fees (except psychological consultation conducted by secondary and tertiary mental health prevention and control institutions), including pulse meter, microcirculation tester, meridian diagnostic instrument (including computer diagnostic instrument of traditional Chinese medicine) and vital information diagnostic instrument.
7. Various medical appraisal items: such as labor ability appraisal (diagnosis and appraisal of workers' labor, work-related injuries and occupational diseases), judicial appraisal of mental patients, medical accident appraisal, and various inspection expenses.
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.
Thirtieth 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.