What Is Insurance Reimbursement?
What is the scope of medical insurance reimbursement? When reimbursing, many people do not quite understand why some medicines can be reimbursed, but some medicines are not reimbursed. It is particularly strange that medicines that they cannot reimburse, and why others can reimburse for the same medical insurance. It also brings joy or anxiety to different participants. Therefore, we fully understand the scope of medical insurance reimbursement. Medical insurance is fair to everyone. Whether we can enjoy the benefits it brings us depends on whether we are familiar with the "rules of the game".
Medical insurance reimbursement scope
- Chinese name
- Medical insurance reimbursement scope
- Chinese name:
- Medical insurance reimbursement scope
- What is the scope of medical insurance reimbursement? When reimbursing, many people do not quite understand why some medicines can be reimbursed, but some medicines are not reimbursed. It is particularly strange that medicines that they cannot reimburse, and why others can reimburse for the same medical insurance. It also brings joy or anxiety to different participants. So we fully understand the scope of medical insurance reimbursement. Medical insurance is fair to everyone. Whether we can enjoy the benefits it brings us depends on whether we are familiar with the "rules of the game".
- medical insurance
- 1. Outpatient compensation:
(1) Village clinics and village center clinics reimburse 60% of the consultations, and the prescription drug fee limit for each visit is 10 yuan, and the doctor's temporary rehydration prescription drug limit for hospitals is 50 yuan.
(2) The town health center reimburses 40% of the medical consultation, and the limit of each examination and operation fee is 50 yuan, and the prescription drug limit is 100 yuan.
(3) The reimbursement of 30% for the second-level hospital will be 50 yuan for each examination and surgery fee, and 200 yuan for the prescription drug fee.
(4) The third-level hospital will reimburse 20% of the consultation fee, and the limit of each examination fee and operation fee will be 50 yuan, and the prescription drug fee limit will be 200 yuan.
(5) The Chinese medicine invoice is attached with a prescription limit of 1 yuan.
(6) The annual compensation limit for township cooperative medical clinics is 5,000 yuan.
- 2. Hospitalization compensation
(1) Reimbursement scope:
A. Drug expenses: auxiliary examination: ECG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, MRI and other examination fees are limited to 200 yuan; surgery fees (refer to national standards, more than 1,000 yuan 1,000 yuan reimbursement).
B. The elderly over 60 years of age are hospitalized in the Xingta Town Health Center. The treatment and nursing expenses are compensated by 10 yuan per day, and the limit is 200 yuan.
(2) Reimbursement ratio:
- The town health center reimburses 60%; the secondary hospital reimburses 40%; the tertiary hospital reimburses 30%.
- 3. Compensation for serious illness
(1) Town risk fund compensation: All in-patients participating in rural cooperative medical insurance have a one-time or full-year reimbursable medical expenses that are more than 5,000 yuan, which is 65% compensation, and 5001-110,000 yuan compensation 70 %.
(2) The annual limit of compensation for township cooperative medical inpatient and uremia outpatient hemodialysis, tumor outpatient radiotherapy and chemotherapy is 11,000 yuan.
The following are not covered by the rural cooperative medical insurance:
1. Seek medical treatment by yourself (not designated hospital or referral form), self-purchased medicines, medicines that cannot be reimbursed under public medical regulations, and medical expenses that do not meet family planning requirements;
2. Out-patient treatment costs, out-patient costs, hospitalization costs, meals costs, escort costs, nutrition costs, blood transfusion costs (except those who have family blood storage, reimbursed in accordance with relevant regulations), heating and cooling costs, ambulance costs, special care costs and other costs ;
3. Medical expenses for car accidents, fights, suicides, alcohol abuse, work-related injuries and medical accidents;
4. Orthopedics, plastic surgery, dental implants, prosthetics, organ transplants, roll-call surgery fees, consultation fees, etc .;
5, within the scope of reimbursement, outside the limit.
Many farmers have purchased some commercial medical insurance after purchasing the "New Rural Cooperative Medical Service". If you purchase commercial medical insurance, you must first reimburse the cost of the "New Rural Cooperative Medical Service" and then seek insurance companies for reimbursement for the remaining expenses.
- Medicare reimbursement comics
- Medicare reimbursement comics
- I. Scope of diagnosis and treatment items for which basic insurance does not pay
- (I) Service Items
- 1. Registration fee, out-of-hospital consultation fee, medical record cost, etc .;
2. Special-needed medical services such as out-patient fees, expedited examination and treatment fees (except for emergency department), surcharges for roll-call surgery, high-quality premium rates, and special nurse fees.
- (2) Non-disease treatment item categories 1. Various beauty (life beauty, medical beauty) bodybuilding items, non-functional cosmetic surgery, orthopedic surgery, etc .;
2. Various weight loss, weight gain and heightening projects;
3. Various health examinations;
4. Various preventive and health-care diagnosis and treatment items;
- Medicare reimbursement
- (2) Non-disease treatment items
- 1. Various beauty (life beauty, medical beauty) bodybuilding projects, non-functional cosmetic procedures, orthopedics, etc.
2. Various weight loss, weight gain and heightening projects;
3. Various health examinations;
4. Various preventive and health-care diagnosis and treatment items; 5. Dental orthodontics and dental porcelain;
6. Various medical consultations (excluding psychiatric consultations) and medical appraisal.
- (Three) diagnosis and treatment equipment and medical materials
- 1. The use of positron emission tomography devices, electron beam CT, ophthalmic excimer laser therapeutic equipment and other large medical equipment for inspection and treatment projects
2. Glasses, dentures, prosthetics, prosthetics, hearing aids and other rehabilitation equipment;
3. A variety of self-use health care, massage, rehabilitation and treatment equipment.
- (IV) Treatment items
- 1. Organ or tissue sources of various organ transplants or tissue transplants;
2. Transplantation of other organs or tissues except kidney, heart valve, cornea, skin, blood vessel, bone, bone marrow transplantation;
3. Myopia orthopedics;
4. Qionggong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment items.
- (V) Other
- 1. Diagnosis and treatment of various infertility (pregnancy) and sexual dysfunction;
2. Various scientific research and clinically validated diagnosis and treatment projects;
2. Scope of diagnosis and treatment items covered by basic medical insurance (1) Diagnosis and treatment equipment and medical materials 1. Application of X-ray computed tomography (CT), stereotactic radiation (-knife, -knife), Cardiac and angiographic X-ray machines (including digital subtraction equipment), magnetic resonance imaging equipment (MEI), single-photon emission computer scanning equipment (SPECT), color Doppler, medical linear accelerator and other large medical equipment , Treatment items;
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3. Pacemakers, artificial joints, artificial lenses, artificial organs for intravascular replacement of vascular stents, and materials placed in the body;
4. Disposable medical materials that can be charged separately according to the provincial price department.
(2) Treatment item category 1, hemodialysis, peritoneal dialysis;
2. Kidney, heart valve, cornea, skin, blood vessel, bone, bone marrow transplantation;
3. Heart laser drilling, anti-tumor cell immunotherapy and fast neutron therapy projects. [1]
Hearing aids and other rehabilitation appliances;
3. A variety of self-use health care, massage, rehabilitation and treatment equipment.
(3) Treatment item category 1. Organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of other organs or tissues except kidney, heart valve, cornea, skin, blood vessel, bone, bone marrow transplantation;
3. Myopia orthopedics;
4. Qionggong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment items.
(4) Other 1. Diagnosis and treatment items of various infertility (pregnancy) and sexual dysfunction;
2. Various scientific research and clinically validated diagnosis and treatment projects;