1, the basic medical insurance fund covers medical expenses that meet the standards of drug list, diagnosis and treatment items and medical service facilities;
2, emergency and rescue medical expenses are also within the scope of payment;
3 payment standards in accordance with state regulations;
4. Self-funded items or self-funded parts will not be reimbursed.
To manage and supervise the basic medical insurance fund;
1. Fund receipt and payment management: involving fund receipt and payment process and management system;
2. Provisions on the use of funds: including the scope, standards and restrictions on the use of funds;
3. Fund supervision mechanism: auditing, monitoring and anti-fraud measures involving the use of funds;
4. Capital risk control: including risk assessment and coping strategies of capital reserve;
5. Fund information disclosure: involving the revenue and expenditure of the fund, the transparency of management efficiency and the protection of the public's right to know.
To sum up, the payment scope of the basic medical insurance fund mainly covers the expenses that meet the national drug list, diagnosis and treatment items and medical service facilities standards, including emergency and rescue expenses, and follows the payment standards stipulated by the state, but does not include self-funded items and personal self-funded medical expenses.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 23
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.