The medical insurance diagnosis and treatment items include:

1. The necessary, safe and effective clinical diagnosis and treatment items with appropriate expenses;

2. The diagnosis and treatment items within the designated medical service scope provided by designated medical institutions for the insured;

third, the price department has formulated the charging standard for diagnosis and treatment projects;

fourth, other diagnosis and treatment projects.

According to the basic medical insurance regulations for urban workers in China and relevant laws and regulations, the scope of medical insurance reimbursement is as follows:

First, drugs that are allowed to be reimbursed within the scope of basic medical insurance reimbursement;

Second, medical treatment items that are allowed to be reimbursed within the scope of reimbursement of basic medical insurance;

thirdly, the 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.

What is the reimbursement ratio?

After excluding the non-reimbursable expenses, the reimbursable expenses are discounted according to the different levels of medical institutions: 1% in township hospitals in this city, 9% in municipal hospitals in this city, 8% outside the city, and 6% without referral certificate. After the discount, the expenses will be settled in proportion by sections: 45% will be reimbursed within 4, yuan; 55% reimbursement for 41-8 yuan; 65% reimbursement for 81-12 yuan; 121-2 yuan reimbursement 75%; More than 2, yuan will be reimbursed 8%. The maximum amount of compensation per person per year shall not exceed 3, yuan.

Legal basis

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.

article 29

the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency, medical institutions and pharmaceutical trading units.

the social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in different places, so as to facilitate the insured to enjoy the basic medical insurance benefits.

Article 28 of the Regulations of the People's Republic of China on the Basic Medical Insurance for Urban Workers

Personal accounts are used to pay medical expenses beyond the scope of the overall fund; If the personal account is insufficient to pay, it shall be borne by me.