Shenzhen urban workers' social medical insurance cash reimbursement management measures (2)

Article 7 The costs of outpatient pre-production check, hospitalization expenses for childbirth, post-natal visits, and basic medical expenses for family planning operations (excluding baby costs) of the insured persons participating in maternity medical insurance outside the city) paid by the maternity medical insurance fund. In addition to the materials, marriage certificates, organization certificates, and birth permits (Second Child) stipulated in Article 4 of these Measures, the reimbursement of hospitalization expenses for childbirth must also be based on birth permits; reimbursement of the costs for family planning surgery must also be based on birth control procedures, go to the Municipal Social Insurance Institution to approve reimbursement according to regulations. Prenatal check includes the following basic items: first check: (established before 13 weeks) Shenzhen Maternal and Child Health Manual; urine HCG, gynecological examination, blood routine (3 categories), urine routine (10 categories), electrocardiogram, B-ultrasound; second examination (16-18 weeks) obstetric examination (including Fetal Heart Doppler), blood type (ABO, RH), blood routine, urine routine, renal function (3 items) liver function (5 items), hepatitis B half, hepatitis C virus antibody, syphilis serum antibody, blood sugar; third check: (20-24 weeks) obstetric examination, urine routine, color B ultrasound; fourth check: (24-28 weeks) obstetric examination, urine routine; fifth check: (28-30 weeks) obstetric examination, urine routine; sixth check: (30-32 weeks) obstetric examination, blood routine, urine routine, B ultrasound; seventh check: (-34 weeks) Obstetric check, urine routine; eighth check: (34-36 weeks) Obstetric check, fetal monitoring, urine routine; ninth check: (37 weeks) Obstetric check, urine routine; tenth check: (38 weeks) obstetrics check, fetal monitoring, urine routine; 11th check: (39 weeks) obstetrics check, urine routine, B-ultrasound; 12th check: (40 weeks) obstetrics Examination, fetal monitoring, urine routine. Family planning procedures include: (1) Placement (removal) of the intrauterine device; (2) artificial termination of pregnancy (abortion), including artificial abortion (negative pressure suction, scraping) mid-term pregnancy leads, drug termination of pregnancy; (3) Placement and removal of subcutaneous implants; (4) tubal sterilization and VAS; (5) fallopian tube resumption and VAS. Article 8 The hospitalization expenses incurred during the period of going abroad, going to Hong Kong, Macao, or Taiwan for public work or visiting relatives shall be reimbursed in accordance with the reimbursement standards of municipal hospitals in this Municipality. The costs of outpatient and drug purchase shall not be reimbursed. For reimbursement, in addition to the materials required in section 1 of Article 4 of these Measures, the applicant shall also provide proof of the Organization, a passport to go abroad or a special pass for Hong Kong, Macao and Taiwan. Article 9 The expenses of the outpatient basic medical expenses of the insured person involved in the comprehensive medical insurance and the medicines and medical treatment items used by the outpatient department to supplement the medical insurance drug Catalog shall be paid by the personal account. If the individual account is insufficient to pay, the annual average salary of urban workers is more than 10%, and the total fund of basic medical insurance pays 70%, 30% for individuals. The insured shall, within the next year of medical insurance, go to the Municipal Social Insurance Institution to review the reimbursement based on the information stipulated in article 4, paragraph 1 of these measures. Article 10 The local supplementary medical insurance insured shall pay the maximum amount of basic medical expenses paid by the Basic Medical Insurance Co-ordination fund and the expenses of medicines and medical treatment items used to supplement the medical insurance drug catalog during hospitalization, after approval, the local supplementary medical insurance fund will pay 85% yuan, and the individual will pay 15% yuan. Article 21 The cost of blood transfusion (whole blood, component blood) due to illness shall be paid by an individual in cash, in accordance with the materials provided in Article 4 of these Measures and the evidence of blood for rescue, to the Municipal Social Insurance Institution for approval of reimbursement, the Basic Medical Insurance Co-ordination Fund pays 90%, and the individual pays 10%. Article 17 The Municipal Social Insurance Institution approves the use of disposable medical materials with a unit price of more than 12th yuan in basic medical insurance projects, the basic medical insurance co-ordination Fund pays 90% of the price based on the domestic universal type (including domestic disposable medical materials), and 50% of the price based on the imported universal type. Article 21 The basic medical expenses for organ transplantation procedures shall be approved and reimbursed as required. The cost of purchasing an organ or tissue source is self-care. Organ transplantation scope: kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow transplantation. Article 14 The cost of resettlement and replacement of artificial organs shall be reimbursed to the Municipal Social Insurance Institution for approval in accordance with the provisions stipulated in Article 4 of these Measures. Artificial organs include artificial heart pacemakers, artificial heart valves, artificial crystals, and artificial joints. The cost of artificial organs is reimbursed at 90% of the price of domestic popular models; the cost of non-domestic popular models is charged at 50% of the price of imported popular models. The maximum reimbursement amount is 15000 yuan for pacemaker, 8000 yuan for artificial heart valve, 5000 yuan for artificial joint, and 1500 yuan for artificial crystal. Article 14 special medical materials include cardiovascular catheter, cardiovascular stent, and cardiovascular balloon. Special medical materials are reimbursed at 90% of the price of domestic popular models; comparable prices of non-domestic popular models are reimbursed at 50% of the price of imported popular models. The maximum reimbursement quota is: 1200 yuan for the cardiovascular catheter, 11500 yuan for the cardiovascular stent, and 6500 yuan for the balloon in the cardiac vessels. Article 21 The insured's cost for dialysis (hemodialysis and peritoneal dialysis) in the outpatient service due to chronic renal failure, antirejection medication in the outpatient service after organ transplantation, chemotherapy, interventional therapy, radiotherapy, or native therapy in the outpatient service for malignant tumors, the patient first advances in cash, and then goes to the Municipal Social Insurance Institution for approval of reimbursement based on the information stipulated in Article 4 of these Measures. The expenses of the patient shall be paid by the basic medical insurance overall planning fund of 90%, and the individual shall pay by 10%. Article 21 These Measures shall be implemented as of the date of issuance.