We know that our country's medical security system is becoming more and more perfect, but of course not all medical expenses can be reimbursed. This is also understandable. For example, many women now go for plastic surgery, which certainly cannot be reimbursed.

Next, let’s take a look at what is covered by medical insurance reimbursement? 1. What is covered by medical insurance reimbursement? According to regulations, there are five categories of diagnosis and treatment items that basic medical insurance does not cover.

The first category is service items: some medical service fees, out-of-hospital consultation fees, medical record costs, etc.; consultation fees, expedited examination and treatment fees, roll-call surgery surcharges, roll-call surgery surcharges, high-quality and low-price fees, self-recruitment of special nurses

and other special medical services.

The second category is non-disease treatment items: see the analysis below for details.

The third category is diagnostic and treatment equipment and medically useful materials: examination and treatment projects using large-scale medical equipment such as positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy equipment.

Glasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitation equipment.

Various self-use health care, massage, examination and treatment equipment.

The price departments of various provinces stipulate that disposable medical materials are not charged separately.

The fourth category is the treatment item category: organ sources or tissue sources for various types of organ or tissue transplantation; transplantation of other organs or tissues except kidney, heart valve, cornea, skin, blood vessel, bone, and bone marrow transplantation; orthopedic surgery for myopia;

Qigong therapy, music therapy, health nutritional therapy, magnetic therapy and other auxiliary treatment projects.

The fifth category is other categories: various scientific research and clinically verified diagnosis and treatment projects, etc.

In addition, the basic medical insurance does not cover the following expenses: transportation fees, ambulance fees; baby incubator fees, food incubator fees, caregiver fees, cleaning fees, outpatient decoction fees; meal fees and other special living service fees

wait.

Patients must pay for the above-mentioned items themselves when seeking medical treatment.

Among them, non-disease treatment items include: 1. Various beauty and plastic surgery items: such as acne, scar beauty, laser beauty, cosmetic tooth cleaning, hair transplantation, etc.

2. Orthopedic treatment items: stuttering, irregular dentition, denture repair (including post crowns, crowns, and installation of dentures), dental implants, snoring surgery (except for respiratory distress syndrome), flat feet and other items (congenital torticollis, lip

Except for cleft palate and sequelae of poliomyelitis).

3. Various bodybuilding treatment projects: such as weight loss, weight gain, height gain, etc.

4. Various health examination items: such as employee physical examination, disease screening, etc.

5. Various preventive and health-related diagnosis and treatment projects: such as various vaccinations, fitness massage, etc.

6. Various medical consultations and health prediction diagnosis and treatment items: such as various disease consultation fees (except for psychological consultations carried out by second- and third-level mental health prevention and treatment institutions), finger pulse meters, microcirculation testers, and meridian diagnostic instruments (including traditional Chinese medicine computers)

diagnostic instrument), life information diagnosis and treatment instrument, etc.

7. Various medical appraisal projects: such as labor ability appraisal (diagnosis and appraisal of employee labor, work-related injuries, and occupational diseases), judicial appraisal of mental patients, medical accident appraisal, various injury examination fees, etc.

2. Is there a time limit for medical reimbursement? There is no time limit for medical reimbursement.

(1) Settlement procedures for hospitalization and outpatient treatment of special diseases. Designated medical institutions shall submit the cost settlement statements, hospitalization settlement statements and relevant information of patients discharged last month to the medical insurance agency before the 10th of each month. The medical insurance agency

After review, it will be used as the basis for monthly appropriation and year-end final accounts.

The medical insurance agency pre-allocates the overall cost of hospitalization and outpatient treatment for special diseases in the previous month every month.

Insured persons who are identified as suffering from special diseases should go to a designated medical institution designated by the labor and social security department to seek medical treatment and purchase medicines. The medical expenses incurred will be directly recorded and settled immediately.

(2) Emergency Settlement Procedure Insured persons are hospitalized in non-designated medical institutions or medical institutions in other places due to emergency rescue. The medical expenses incurred shall be paid in advance by the individual or unit. After the emergency rescue is completed, the medical expenses incurred shall be paid based on the hospital emergency medical records and examination.

, laboratory reports, invoices, and detailed medical fee lists until the medical insurance agency handles the reimbursement procedures in accordance with regulations.

(3) Settlement procedures for relocation of personnel 1. For relocation of relocation workers, the unit where they work shall designate 1-2 designated medical institutions in their place of residence and report them to the medical insurance agency for record.

2. The medical expenses incurred by out-of-town workers who are ill and go to designated medical institutions in their place of residence will be paid in advance by the person or their unit. After the treatment is completed, the unit will pay the insured person's medical certificate and medical record, valid expense receipt, and duplicate

Prescriptions, hospitalization expense lists, etc. must be settled at the social medical insurance agency on the specified date.

(4) Referral and transfer settlement 1. If the insured person is transferred to other medical institutions for diagnosis and treatment due to limited conditions of designated medical institutions or due to specialized diseases, he must fill in the transfer approval form.

The treating physician will put forward the reasons for the transfer, the department director will put forward the opinion on the transfer, the medical insurance office of the medical institution will review it, the director in charge will sign, and the case will be transferred to the municipal medical insurance center for approval.

2. In principle, referrals should be made within the city first and then outside the city, and first within the province before outside the province.