1, drugs allowed to be reimbursed within the reimbursement scope of basic medical insurance;
2, within the scope of the basic medical insurance reimbursement allows reimbursement of diagnosis and treatment projects;
3 expenses incurred by medical service facilities that are allowed to be reimbursed within the scope of reimbursement of basic medical insurance.
According to the relevant laws and regulations, the scope of medical insurance reimbursement refers to ensuring the basic medical needs of the insured, and standardizing the medication and diagnosis and treatment management of basic medical insurance. The basic medical insurance stipulates the scope of reimbursement for drug list, diagnosis and treatment items and medical service facilities. The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
The broad medical insurance coverage includes the objects covered by medical insurance, the proportion of medical expenses and the health services covered. Medical insurance coverage in a narrow sense includes medical services covered by medical insurance, as well as the quantity, forms and restrictions provided by these items.
The broad medical insurance coverage includes the objects covered by medical insurance, the proportion of medical expenses and the health services covered. Medical insurance coverage in a narrow sense includes medical services covered by medical insurance, as well as the quantity, forms and restrictions provided by these items. The main performance is as follows:
1. Insurance companies provide insurance for certain groups of people.
Insurance companies don't provide insurance for some people.
3. The insurer pays a certain proportion of medical expenses for the insured or starts to pay from a certain level of expenses.
Insurance company will not pay more than a certain amount of medical expenses.
5. The insurer reimburses the medical expenses of one or more diseases for the insured.
6. The insurer does not reimburse the medical expenses of the insured for one or more diseases.
7. The insurer provides a certain amount of certain types of medical services for the insured free of charge (or partially free of charge).
8. The insurer does not provide certain medical services for the insured free of charge (or partially free of charge).
In practice, a specific medical insurance system will not only use one of the above forms to determine medical insurance coverage, but will combine several forms to determine medical insurance coverage. Generally speaking, the insurer's liability to the insured is within a certain range, that is, its liability is limited rather than unlimited.
legal ground
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.