What expenses are generally not reported for hospitalization reimbursement?

The following hospitalization expenses cannot be reimbursed:

1, transportation expenses for medical treatment and referral and first aid expenses;

2. Air conditioning fee, TV fee, telephone fee, baby incubator fee and food incubator fee;

3, escort fees, nursing fees, washing fees, outpatient decocting fees;

4. diet;

5. Hospitality and other special life service expenses. In accordance with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency medical expenses, in accordance with the provisions of the basic medical insurance fund to pay.

There are three things that social security has not reported:

(1) Deductible is not reported: it can be simply understood that if it is lower than this amount, it will not be reimbursed and social security will not be considered.

(2) Not reporting above the cap amount: Social security not only has deductibles, but also has a cap line. Even if it exceeds this amount, social security will not compensate.

(3) Self-funded part is not reported: social security also has self-funded part, and the self-funded part is social security regardless of compensation.

legal ground

People's Republic of China (PRC) social insurance law

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

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.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

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.