The scope of medical insurance reimbursement is as follows:

1, drugs allowed to be reimbursed within the reimbursement scope of basic medical insurance;

2, within the scope of the basic medical insurance reimbursement allows reimbursement of diagnosis and treatment projects;

3 expenses incurred by medical service facilities that are allowed to be reimbursed within the scope of reimbursement of basic medical insurance. Reimbursement expenses are mainly paid by the overall fund, and individuals have to pay a corresponding part.

The medical insurance reimbursement of hospitalization examination items shall be carried out according to the following procedures:

1. When the patient goes to the hospital for examination, the doctor will issue corresponding examination items according to the condition and examination results;

2, patients with inspection project documents and medical insurance card, to the medical insurance designated institutions for settlement and reimbursement;

3, medical insurance designated institutions after receiving the inspection project documents, according to the provisions of the medical insurance policy and the patient's personal account balance, settlement and reimbursement;

4. After the patient pays the personal expenses, the designated medical insurance institution will reimburse the remaining expenses to the patient.

To sum up, the scope of medical insurance reimbursement inspection items is limited, and different regions and medical insurance policies will be different. Before carrying out the examination items, patients need to know the medical insurance policy, medical insurance reimbursement ratio and restrictive conditions in their own areas, and choose the examination items suitable for them under the guidance of doctors. In addition, in order to facilitate the settlement of reimbursement, patients are advised to know their medical insurance card balance and the prescribed reimbursement process in advance before seeing a doctor.

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.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by the 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.