Genetic testing is not currently reimbursable by medical insurance in most areas. Currently, there are two places in the country where genetic testing has been included in the scope of medical insurance reimbursement, namely Beijing and Fujian. Beijing was the first country in the country to include genetic testing in medical insurance, starting on June 15, 2019. In the "Notice on Standardizing and Adjusting the Price of Pathology and Other Medical Services" issued by Beijing, tumor tissue deoxyribose acid (DNA) sequencing costs 3,800 yuan, which belongs to Beijing Medical Insurance Category B. Medical insurance reimburses 92%, and the individual bears 8 %. On November 28, 2022, the Fujian Provincial Medical Insurance Bureau issued a notice on some medical service items and prices, among which genetic testing was officially included in the Fujian Provincial Medical Insurance.
Genetic testing is an examination method used for disease diagnosis, assessment of disease severity and prognosis. Genetic testing is of great value in the diagnosis and condition assessment of hematological malignant diseases such as acute leukemia, myeloproliferative neoplasms, lymphomas, etc. Although the cost of genetic testing cannot be reimbursed, if the condition requires it, patients are still recommended to complete relevant DNA Testing. Genetic testing includes many items, and the cost of each item is relatively high. Genetic testing items need to be selected after the doctor evaluates the condition, so as to reduce the patient's financial burden as much as possible without affecting the diagnosis and treatment of the patient's disease. Genetic disease diagnosis uses genetic testing technology to detect mutated genes that cause hereditary diseases. The most widely used genetic testing at present is the detection of genetic diseases in newborns, the diagnosis of genetic diseases and the auxiliary diagnosis of some common diseases.
According to the regulations on basic medical insurance for urban employees in my country and relevant laws and regulations, the scope of medical insurance reimbursement is as follows:
1. Drugs that are allowed to be reimbursed within the reimbursement scope of basic medical insurance;
2. Diagnosis and treatment items that are allowed to be reimbursed within the scope of basic medical insurance reimbursement;
3. Expenses incurred by medical service facilities that are allowed to be reimbursed within the scope of basic medical insurance reimbursement. Reimbursement expenses are mainly paid by the overall fund, and individuals also have to pay a corresponding part.
Medical insurance reimbursement ratio: Generally speaking, the economic development situation of different regions is different, so the reimbursement ratio is also different. The following is an explanation of the insurance ratio of Beijing employee medical insurance. After enrolling in medical insurance, if you are an active employee, you can only reimburse for medical expenses exceeding 1,800 yuan after going to the hospital's outpatient clinic or emergency room, and the reimbursement rate is 50%. . For retirees under the age of 70, expenses above 1,300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old, 80% of expenses above 1,300 yuan can be reimbursed.
Legal Basis
"Social Insurance Law of the People's Republic of China"
Article 4 Employers and individuals within the territory of the People's Republic of China Pay social insurance premiums in accordance with the law, have the right to inquire payment records and personal rights records, and require social insurance agencies to provide social insurance consulting and other related services.
Individuals enjoy social insurance benefits in accordance with the law and have the right to supervise the payment of contributions by their units.
Article 5 People’s governments at or above the county level shall incorporate social insurance undertakings into national economic and social development plans.
The state raises social insurance funds through multiple channels. People's governments at or above the county level shall provide necessary financial support to social insurance undertakings.
The state supports social insurance through preferential tax policies.
Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit. The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.
"Regulations of the People's Republic of China on the Management of Human Genetic Resources"
Article 2: Human genetic resources as mentioned in these regulations include human genetic resource materials and human genetic resource information. Human genetic resource materials refer to organs, tissues, cells and other genetic materials containing human genome, genes and other genetic materials. Human genetic resource information refers to data and other information materials generated by using human genetic resource materials.
Article 3: The collection, preservation, utilization and external provision of my country’s human genetic resources shall comply with these regulations. For the needs of clinical diagnosis and treatment, blood collection and supply services, investigation and prosecution of illegal crimes, doping testing, funerals and other activities, the collection and preservation of organs, tissues, cells and other human substances and related activities shall be carried out in accordance with relevant laws and administrative regulations.
Article 12 When collecting human genetic resources in my country, providers of human genetic resources must be informed in advance of the purpose of collection, use of collection, possible impacts on health, personal privacy protection measures, and their rights to voluntary participation and at any time. The right to unconditionally withdraw with the written consent of the provider of human genetic resources. When informing providers of human genetic resources the information specified in the preceding paragraph, it must be comprehensive, complete, true, and accurate, and must not be concealed, misled, or deceived.