Zhuhai Basic Medical Insurance Drug List, Medical Treatment Items and Medical Service Facilities Standard Management

Zhuhai Basic Medical Insurance Drug List, Medical Treatment Items and Medical Service Facilities Standard Management Measures are applicable to the insured who have already participated in this city's basic medical insurance and the designated medical institutions that provide basic medical insurance services. The following is the interpretation of Zhuhai Basic Medical Insurance Drug List, Diagnosis and Treatment Items and Standard Management Measures for Medical Service Facilities. Welcome to browse!

The first part of the object of protection

1. What are the applicable objects of the Measures for the Administration of Specific Diseases in Basic Medical Insurance Outpatients in Zhuhai (hereinafter referred to as the Measures)?

a: these measures are applicable to the insured who have participated in the basic medical insurance in this municipality and the designated medical institutions that provide basic medical insurance services.

Part II List of Medicines for Basic Medical Insurance

2. What medicines can be included in this Municipality's basic medical insurance pooling fund (hereinafter referred to as pooling fund) for payment?

a: it conforms to the national drug list of basic medical insurance, work-related injury insurance and maternity insurance (hereinafter referred to as the national drug list), the drug list of basic medical insurance, work-related injury insurance and maternity insurance in Guangdong province (hereinafter referred to as the drug list), the scope of overall drug use in general outpatient clinics of basic medical insurance in Guangdong province (hereinafter referred to as the scope of overall drug use in outpatient clinics), and the basic medical insurance in Guangdong province. Drugs in the scope of compound drugs in the drug list of work-related injury insurance and maternity insurance (hereinafter referred to as the scope of compound drugs in the drug list), as well as drugs specified to be paid in the documents issued by the Provincial Department of Human Resources and Social Security, are included in the scope of payment of the city's overall fund.

the list of drugs for specific diseases in the outpatient department of the basic medical insurance in this municipality shall be formulated by the municipal social insurance administrative department.

3. Are the national and provincial essential drugs managed according to the provisions of Class A or Class B drugs?

a: the national and provincial essential drugs are implemented according to the provisions of class a drugs.

4. how to pay for the drugs used by the insured in outpatient and hospitalization?

Answer: When the insured person of basic medical insurance uses the drugs in the National Drug Catalogue, Drug Catalogue, Outpatient Overall Drug Use Scope and Compound Drug Scope, as well as the drugs to be paid in the documents issued by the province, the overall fund will pay according to the basic medical insurance regulations of this Municipality. Among them, the use of some drugs (see annex) is paid by individuals at their own expense, and then paid according to the basic medical insurance regulations of this Municipality.

5. how to manage therapeutic self-made preparations in designated medical institutions?

a: the therapeutic self-made preparations approved by the relevant departments and approved by the designated medical institutions, after being reported to the municipal social insurance agency for the record, will be included in the payment scope of the overall fund, and will be restricted to use in the designated medical institutions according to the provisions of Class A drugs.

Part III Basic Medical Insurance Diagnosis and Treatment Project

VI. What does the basic medical insurance diagnosis and treatment project mean?

Answer: The basic medical insurance diagnosis and treatment project refers to all kinds of medical technical services projects that meet the following conditions and projects that use medical instruments, equipment and medical materials for diagnosis and treatment:

(1) It is clinically necessary, safe and effective, and the cost is appropriate.

(2) the charging standard is announced by the competent price department.

7. What are the basic medical insurance diagnosis and treatment items?

A: There are two types of basic medical insurance diagnosis and treatment projects: those whose expenses are paid by pooling funds and those whose expenses are not paid by pooling funds.

8. How much should the individual insured pay at his own expense first and then according to the provisions of the basic medical insurance in this Municipality for the medical treatment projects paid by the overall fund?

a: the medical treatment items that are paid by the overall fund are paid by the insured person at his own expense, and then paid according to the basic medical insurance regulations of this municipality.

(1) Medical technology diagnosis and treatment

For inspection and inspection items with unit price above 3 yuan (inclusive), the individual shall pay 5% at his own expense first.

(II) Treatment items

For treatment items with unit price above 1 yuan (inclusive), the individual shall pay 5% at his own expense first.

(III) Material items

For the one-time material fee with a unit price of more than 2, yuan (inclusive), the individual shall pay 1% at his own expense first.

9. What are the diagnosis and treatment projects that the overall fund will not pay?

A: The diagnosis and treatment items that are not paid by the overall fund:

(1) Service items

1. Registration fees, out-of-hospital consultation fees, various special consultation fees, medical record cost, various materials fees, etc.

2. Visiting fees, visiting fees, expedited fees for examination and treatment, overtime fees, and special medical services such as self-invited nursing, family medical care services, and high-quality and good-price fees (such as attendance surgery, hourly surgery, attendance consultation, attendance examination, attendance nursing fees, etc.).

(II) Non-disease treatment items

1. Various cosmetic and bodybuilding items and non-functional cosmetic and orthopedic surgery and other related diagnosis and treatment items (such as double eyelid surgery, breast augmentation surgery, myopia orthopedic surgery, correction of stuttering, treatment of freckles, age spots, pigmentation, bromhidrosis, hair loss, cosmetic scar removal, laser cosmetic wart removal, cosmetic tooth cleaning and dental inlay).

2. Costs of various weight loss, weight gain and weight increase projects.

3. various health checkups, such as premarital checkup, travel checkup, occupational checkup, exit checkup and other expenses.

4. Various preventive and health care items (e.g., various vaccinations, general disease screening and treatment, follow-up fees, etc.).

5. all kinds of medical consultation and medical appraisal (such as psychological consultation, health consultation, sex consultation, marriage and childbearing consultation, disease prediction fee, medical accident appraisal, psychiatric forensic appraisal, various injury and disability grade appraisal, labor ability appraisal, fetal sex appraisal, paternity test, genetic gene appraisal, etc.).

6. It is a health care full-body massage fee.

7. all kinds of health care expenses, rehabilitation treatment with daily life and entertainment articles and their supplies.

(III) Diagnosis and treatment equipment and medical materials

1. Expenses for examination and treatment by using positron emission tomography (PET-CT), electron beam CT, ophthalmic excimer laser therapeutic instrument, and human information diagnostic instrument.

2. Rehabilitation appliances such as glasses, dentures, artificial eyes, artificial limbs, hearing AIDS (except the implanted parts of cochlear implants).

3. Various self-used health care, massage, examination and treatment instruments (such as massagers, wheelchairs, crutches, various household detection and treatment instruments, leather steel carapace, waist circumference, steel head and neck, stomach support, kidney support, uterine support, hernia belt, knee pad, testicle lifting belt, brain tonic, medicine pillow, medicine pad, hot compress bag, etc.

4. Disposable medical materials that cannot be charged separately as stipulated by provincial and municipal price departments.

(4) Treatment items

1. Organ source and tissue source of various organ or tissue transplants (except skin transplantation for burn patients).

2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones, bone marrow and transplantation.

3. Liver transplantation (including hepatectomy and retransplantation).

4. strabismus correction.

5. Expenses for treatment items such as music therapy (except mental patients), qigong therapy, health nutrition therapy and psychotherapy (except mental patients).

(5) Others

1. Expenses for diagnosis and treatment of various infertility (pregnancy) and sexual dysfunction.

2. Expenses of various teaching, scientific research and clinical verification diagnosis and treatment projects.

3. Other kinds of insurance premium (such as the insurance premium for various artificial organ implantation operations such as pacemaker installation) and various late payment fees added during hospitalization.

4. Other medical treatment items that are not included in the scope of social insurance fund payment as stipulated by the relevant departments of the state, province and city.

Part IV Standards for Medical Service Facilities of Basic Medical Insurance

X. What do medical service facilities of basic medical insurance mean?

a: the medical service facilities of basic medical insurance refer to the life service facilities provided by designated medical institutions and necessary for the insured to receive diagnosis, treatment and nursing.

Xi. What are the payment scope of medical service facilities of basic medical insurance?

a: the payment scope of medical service facilities of the basic medical insurance mainly includes: inpatient bed fee and outpatient and emergency observation bed fee (including daily necessities, hospital transportation supplies, water and electricity, etc., which have been included in inpatient bed fee or outpatient and emergency observation bed fee).

12. according to what standard does the overall fund pay for hospital beds?

a: the overall fund pays the hospital bed fee according to the following standards. If the actual bed fee of the insured during hospitalization is lower than the corresponding payment standard, it shall be paid according to the actual bed fee; If it is higher than the corresponding payment standard, it shall be paid according to the standard, and the excess shall be paid by the insured at his own expense.

(1) Hospitalized bed fee in tertiary hospitals

1. General ward: 43 yuan/day.

2. laminar flow clean ward: 27 yuan/day.

3. laminar flow clean simple ward: 1 yuan/day.

4. intensive care unit: 7 yuan/day.

5. Special protection ward: 7 yuan/day.

(2) The inpatient bed fees in secondary hospitals and primary hospitals shall be reduced by 1% and 2% respectively according to the above standards.

XIII. What are the expenses of life service items and service facilities that the overall fund will not pay?

Answer: The expenses of life service items and service facilities that are not paid by the pooling fund mainly include:

(1) transportation expenses for (transfer to) a clinic, ambulance visits, and stretcher bearers' visits with an ambulance.

(2) Air conditioning fee, TV fee, telephone fee, food incubator fee, electric stove fee, gas fee, refrigerator fee and compensation fee for damage to public property, electricity fee for self-contained fan, shampoo and hair dryer fee.

(3) escort fee, bed fee, nursing fee, washing fee, outpatient decoction fee and diaper fee.

(4) meals (including nutritious meals and medicated meals).

(5) Fees for books, periodicals, newspapers, recreational activities and other special living services.

(6) various expenses that are not directly related to diagnosis and treatment (such as washbasin expenses, mouth cup expenses, tableware, dental utensils expenses, daily cleaning and sanitation expenses, sanitary plastic bags expenses, slippers expenses, toilet paper expenses, urination and defecation equipment expenses, sewage charges, bottle charging expenses, etc.).

(7) Other expenses that shall not be paid as stipulated by the municipal social insurance administrative department.

Part V Others

XIII. When will the measures be implemented?

a: these measures will be implemented as of February 1, 217. ;