Provisions on social security reimbursement for minors

Medical insurance reimbursement scope:

1, drug cost: auxiliary examination: 200 yuan for ECG, X-ray fluoroscopy, photography, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

2. The elderly over 60 years old are treated in urban hospitals, and the daily compensation for treatment and nursing expenses is 10 yuan, with the limit of 200 yuan.

Drug reimbursement of basic medical insurance

Drugs included in the basic medical insurance payment scope are divided into Class A and Class B. ..

Class A drugs refer to drugs that are basically unified throughout the country and can ensure the basic needs of clinical treatment. The expenses of such drugs are included in the payment scope of the basic medical insurance fund, and the expenses are paid according to the basic medical insurance payment standard.

The list of Class B drugs shall be adjusted by all provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions. Before such drugs are included in the payment scope of the basic medical insurance fund, the employees shall pay according to a certain proportion and pay according to the basic medical insurance payment standard.

Not covered by medical insurance reimbursement.

1. Self-seeking medical treatment (no designated hospital for medical treatment or no referral form), self-purchasing drugs, drugs that cannot be reimbursed according to the regulations of free medical care and medical expenses that do not meet the requirements of family planning.

2. Reimbursement of service facilities is provided by designated medical institutions. The life service facilities necessary for the insured in the process of medical treatment and nursing mainly include hospital bed fee or outpatient and emergency observation bed fee.

3. The expenses of life service items and service facilities that are not paid mainly include: transportation expenses for medical treatment, referral and first aid; Air conditioning fee, TV fee, telephone fee, baby incubator fee, food incubator fee, escort fee, care worker fee, washing fee and outpatient decoction fee; Meal expenses; Hospitality and other special life service expenses.

4. Outpatient treatment fee, visiting fee, hospitalization fee, food fee, escort fee, nutrition fee, blood transfusion fee (except for family blood donors, reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc.

5. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents.

6. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc.

7, within the scope of reimbursement, beyond the limit.

Not covered by the basic medical insurance reimbursement:

1, a drug with tonic effect.

2, some medicinal animals and animal organs, dried (water) fruit.

3. Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces.

4. Fruit preparations and oral effervescent agents in various medicines.

5 blood products and protein products (except for special indications and first aid and rescue).

6, the provisions of the administrative department of social insurance basic medical insurance fund does not pay for other drugs.

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Social security reimbursement scope

Reimbursement conditions

1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.

2. The medical expenses incurred by the insured in the process of medical treatment must conform to the scope and payment standards of the basic medical insurance drug list, medical treatment items and medical service facilities standards, and can be paid by the basic medical insurance fund according to regulations.

3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.