The scope of reimbursement for medical insurance refers to the scope of reimbursement for standardizing basic medical insurance drugs, diagnosis and treatment items and medical service facilities (commonly known as "three records") in order to protect the basic medical needs of the insured.

Medical insurance refers to social medical insurance. It is a social insurance system that meets the basic medical needs of the state and society according to laws and regulations when workers are sick.

Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection.

Medical insurance has the characteristics of "low level and wide coverage". The payment is based on the expenses that most units and individuals can bear at a low level, covering all units and employees in cities and towns, and employees in different units can enjoy the rights of basic medical insurance. The insured can enjoy it for life after completing the payment period. Secondly, the basic medical insurance has the characteristics of "the burden of both parties and the combination of unified accounts"; Based on the principle of "balance of payments".

Personal account of medical insurance is a special account established according to the basic medical insurance policy, which is specially used to store the medical insurance premiums paid by the insured and the funds allocated by the employer according to a certain proportion, and record the medical consumption. The funds in the personal account are used to pay for the out-of-pocket part of medical treatment and medicine purchase.

The basic medical insurance system in China adopts the mode of combining social pooling with individual accounts. The basic medical insurance fund shall, in principle, implement municipal co-ordination. The basic medical insurance covers all employers and their employees in cities and towns; All enterprises, state administrative organs, institutions and other units and their employees must fulfill the obligation to pay the basic medical insurance premium.

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.