1. Basic medical insurance drug reimbursement
Drugs included in the scope of basic medical insurance benefits are divided into two categories: Category A and Category B. Class A drugs refer to drugs that are basically unified across the country and can ensure the basic needs of clinical treatment. The cost of such drugs is included in the payment scope of the basic medical insurance fund, and is paid according to the payment standards of the basic medical insurance.
The catalog of Class B drugs is adjusted by each province, autonomous region, and municipality directly under the Central Government according to its own situation. After employees pay a certain proportion of the cost for such drugs, they are then included in the scope of payment of the basic medical insurance fund and are paid according to the basic medical insurance. Standard payment fees.
The following drugs are not reimbursed by basic medical insurance: (1) Drugs that mainly serve as nutritional supplements; (2) Some animals and animal organs that can be used as medicine, and dried (fruit) fruits; (3) Used Various wine preparations made from Chinese herbal medicines and Chinese herbal medicine pieces; (4) Fruity preparations and oral effervescent preparations in various medicines; (5) Blood products and protein products (except for special indications and first aid and rescue); (6) Other drugs that are not covered by the basic medical insurance fund as stipulated by the social insurance administrative department. 2. Reimbursement of basic medical insurance diagnosis and treatment items
Basic medical insurance diagnosis and treatment items should meet the following conditions: (1) Clinical diagnosis and treatment are necessary, safe and effective, and the cost is appropriate; (2) The charging standards are set by the price department; ( 3) Within the scope of designated medical services provided by designated medical institutions for insured persons.
The scope of diagnosis and treatment items for which basic medical insurance pays part of the fee is determined in accordance with the "Scope of Diagnosis and Treatment Items of Basic Medical Insurance" stipulated by the state. If the diagnosis and treatment items are included in the catalog of partial expenses paid by the basic medical insurance, the insured person will first pay out of pocket according to the prescribed proportion, and then pay according to the provisions of the basic medical insurance. If the diagnosis and treatment items are included in the list of diagnostic and treatment items that are not covered by the basic medical insurance for employees, the basic medical insurance fund for employees will not pay. 3. Reimbursement of basic medical service facilities
The reimbursement of medical service facilities under basic medical insurance covers the living service facilities provided by designated medical institutions and necessary for insured persons to receive diagnosis, treatment and care. It mainly includes inpatient bed fees or outpatient (emergency) outpatient observation bed fees.
The fees for daily services and service facilities that are not covered by the basic medical insurance fund mainly include: (1) transportation fees for (referral) treatment and emergency vehicle fees; (2) air conditioning fees, TV fees, Telephone fees, baby incubator fees, food incubator fees; (3) escort fees, nursing fees, cleaning fees, outpatient medicine decoction fees; (4) meal fees; (5) cultural and entertainment activity fees and other special living service fees. Legal provisions:
Article 29, Paragraph 1, of the "Social Insurance Law of the People's Republic of China" stipulates: "The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be paid by the society. Insurance agencies settle directly with medical institutions and pharmaceutical business units.
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