What expenses can not be reimbursed by medical insurance

Generally speaking, ordinary medical expenses can be reimbursed, but some imported medicines and complex diseases cannot be reimbursed. When you pay the bill at the hospital, the amount labeled as "self-payment" under the bill can be reimbursed, but "capital fee", "self-payment" and other expenses cannot be reimbursed. The reimbursement of basic medical service facilities covers the living service facilities provided by the designated medical institutions, which are necessary for the participants in the process of receiving diagnosis, treatment and care: inpatient beds, outpatient (emergency) observation beds, etc. However, the costs of living service items and service facilities, such as the transportation fee for consultation (referral) and the fee for the emergency ambulance, are not reimbursable.

1, self-medical treatment (without designated hospitals or without referral orders), self-acquired medicines, medicines that cannot be reimbursed under the public medical care regulations, and medical expenses not in accordance with family planning;

2, outpatient treatment fees, consultation fees, hospitalization fees, meals, companion fees, nutritional fees, blood transfusion fees (except for those who have family blood reserves, which are reimbursed according to the relevant regulations), air-conditioning and heating costs, ambulance fees, special Other expenses such as nursing care;

3. Medical expenses for car accidents, fights, suicides, alcoholism, workplace accidents and medical malpractice;

4. Orthopedics, plastic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, etc.

5. Reimbursement of expenses within the scope of reimbursement, but outside the limit.

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A, health insurance reimbursement process is how

Bring all the information to the local social security center relevant departments to apply for processing, after review, complete information, meet the conditions, can be instantly processed.

When the applicant applies for reimbursement of outpatient medical expenses, the amount transferred to the individual account of medical insurance in the current social security year will be deducted first, and then the amount to be reimbursed will be approved.

Second, the attention of medical insurance reimbursement

1, the participant must hold the medical insurance card to the designated medical insurance management window to go through the hospital registration procedures when he/she is admitted to or discharged from the hospital. If you need to be hospitalized, you are required to pay a deposit for the medical expenses in advance, and you will be reimbursed after you are discharged from the hospital.

2. If the insured person needs to be referred or transferred to another hospital due to his condition, he must be referred to another hospital with the consent of the attending physician of the hospital, and then fill in the application form by his unit, and then report to the municipal (district) social security institutions for approval after the approval of the medical insurance management part of the designated medical institutions for the procedure of referral (hospital). Among them, the referral is limited to the provincial special hospital, the cost of which must first be advanced by the person, and its reimbursement rate should be 10%, and then calculate the amount of reimbursement in accordance with local regulations.

3. After being discharged from the hospital, the hospital will calculate the amount of reimbursement from the medical insurance and the amount of personal out-of-pocket payment according to the relevant policies. The amount of reimbursement from the medical insurance can be directly reimbursed at the hospital's medical insurance billing office, while the personal out-of-pocket payment has to be settled by the insured person himself.

4, participants hospitalized in the integrated fund of the starting line standard pieces according to the local policy, will be different, in general, is based on the previous year, the city's average annual wage of 10%, in a basic medical insurance billing year, multiple hospitalization of medical expenses are calculated cumulatively.

Legal basis:

"People's Republic of China*** and the State Social Insurance Law" Article 23 Employees shall participate in the basic medical insurance, by the employer and the employee in accordance with the provisions of the State*** with the payment of basic medical insurance premiums. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in the employing organization, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the provisions of the State.