1, drug reimbursement for basic medical insurance
Drugs included in the basic medical insurance payment range are divided into Class A and Class B ... Class A drugs refer to drugs that are basically unified throughout the country and can ensure the basic needs of clinical treatment. The expenses of such drugs are included in the payment scope of the basic medical insurance fund, and the expenses are paid according to the basic medical insurance payment standard.
The list of Class B drugs shall be adjusted by all provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions. Before such drugs are included in the payment scope of the basic medical insurance fund, the employees shall pay according to a certain proportion and pay according to the basic medical insurance payment standard.
The following drugs are not covered by the basic medical insurance reimbursement: (1) drugs that mainly play a nourishing role; (2) Some animals and animal organs and dried fruits that can be used as medicine; (3) Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces; (4) Fruity preparations and oral effervescent agents in various medicines; (5) Blood products and protein products (except for special indications and first aid and rescue); (six) other drugs that are not paid by the basic medical insurance fund as stipulated by the administrative department of social insurance.
2, the basic medical insurance treatment project reimbursement
The basic medical insurance diagnosis and treatment project should meet the following conditions: (1) Clinical diagnosis and treatment must be safe and effective, and the cost is appropriate; (2) The price department has set the charging standard; (3) within the scope of designated medical services provided by designated medical institutions for the insured.
The scope of basic medical insurance to pay part of the cost of diagnosis and treatment projects is determined in accordance with the scope of basic medical insurance diagnosis and treatment projects stipulated by the state. Belong to the basic medical insurance payment part of the directory of medical treatment project costs, first by the insured according to the provisions of the proportion of self pay, and then pay according to the provisions of the basic medical insurance. Belonging to the basic medical insurance for employees, belonging to the catalogue of medical treatment projects that are not paid, the basic medical insurance fund for employees will not pay.
3. Reimbursement of basic medical service facilities
The reimbursement scope of medical service facilities in the basic medical insurance includes the living service facilities provided by designated medical institutions and necessary for the insured to receive diagnosis, treatment and nursing, mainly including the hospitalization bed fee or outpatient (emergency) observation bed fee.
The expenses of life service items and service facilities not paid by the basic medical insurance fund mainly include: (1) outpatient (transfer) transportation expenses and emergency transportation expenses; (2) Air conditioning fee, TV fee, telephone fee, baby incubator fee and food incubator fee; (3) Escort fee, nursing fee, washing fee and outpatient decocting fee; (4) meals; (5) Hospitality and other special life service expenses.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.