Pien Tze Huang is a national first-class protected traditional Chinese medicine, which does not belong to the scope of medical insurance drugs, so it is not included in the medical insurance reimbursement process.
1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;
2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;
3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;
4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.
Medical insurance reimbursement standard:
1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;
2, urban residents, in a settlement year, the medical expenses that meet the scope of reimbursement are 65,438+10,000 yuan, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 60%;
3. You need to go back to your hometown for reimbursement, and the reimbursement rate is 35-65%, which varies according to the level of the hospital.
To sum up, Pien Tze Huang is not a medical insurance drug and cannot be reimbursed. The drugs in the medical insurance drug list are divided into two categories: A and B. Class A drugs are necessary for clinical treatment, widely used and have good curative effect, and their prices are lower among similar drugs. When the insured uses Class A drugs, they can all be included in the scope of reimbursement and reimbursed according to the prescribed proportion. Class B drugs can be used in clinic with good curative effect, and the price of similar drugs is higher than that of class A drugs. When the insured uses Class B drugs, if the personal burden ratio is not marked, the individual shall bear 10% of the drug expenses first. If the proportion of personal burden is marked, the individual shall bear it first according to the marked proportion. After deducting the personal out-of-pocket expenses, the remaining expenses are included in the scope of reimbursement and reimbursed according to the prescribed proportion.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.