The cost of tumor immunotherapy can be partially reimbursed by medical insurance. After the outpatient emergency expenses of on-the-job employees exceed 2000 yuan, the reimbursement ratio is 50%. Retiree expenses exceed 1.300 yuan, and the reimbursement rate is 70% to 80%. The reimbursement standard of hospitalization expenses depends on the hospital level. The expenses of tertiary hospitals are less than 30,000 yuan, the reimbursement rate of employees is 85%, and the reimbursement rate of more than 40,000 yuan is 95%. The individual contribution ratio of retirees is 60% of the employees. Self-funded items are not within the scope of reimbursement.

Medical insurance policy for immunotherapy;

1, medical insurance catalogue adjustment: regularly update the medical insurance drug catalogue and include some immunotherapy drugs in the reimbursement scope;

2. Formulation of payment standard: according to the clinical effect and cost-benefit ratio of drugs, determine the reimbursement ratio and limit of different drugs;

3. Drug access negotiation: price negotiation with drug manufacturers to bring drugs into medical insurance at a lower price;

4. Standardized management: formulate guidelines and management regulations for the use of immunotherapy drugs to ensure rational use;

5. The patient pays the proportion: according to the drug reimbursement policy, the patient pays the proportion and the self-funded part.

To sum up, the medical insurance reimbursement policy for tumor immunotherapy is that the outpatient and emergency expenses of on-the-job employees exceed 2,000 yuan, 50%, the expenses of retirees exceed 1.300 yuan, 70%-80%, and the hospitalization expenses are reimbursed according to the hospital level. Employees in tertiary hospitals can report up to 95%, and the proportion of individual contributions of retirees is 60% of employees, excluding self-funded projects.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.