(a) the scope of the pilot insured population and designated medical institutions. The medical expenses incurred by provincial-level insured persons in provincial-level designated medical institutions and sporadic reimbursement expenses of provincial-level insured persons will be included in the pilot scope.
(2) New payment items and consumables. 50 medical services and 242 kinds of medical consumables are included in the scope of medical insurance payment, and medical services are limited according to Class B management, and the price limit is the standard of medical insurance payment; Limited medical consumables are paid by medical insurance at a limited price.
(3) Incorporate the floating expenses into the scope of medical insurance payment. The medical service price manual of urban public hospitals in Hebei Province stipulates that "the price of surgical items (code: 330000000) can float upwards 15%", and the floating part is paid according to the main item category.
(four) standardize the provincial medical insurance diagnosis and treatment projects and consumables payment policy. On the basis of implementing the policies and price limits of the Catalogue of Basic Medical Insurance Diagnosis and Treatment Projects and Medical Service Facilities in Hebei Province and the Catalogue of Additional Charges Management Outside disposable goods Province (202 1 Edition), the "Class A" diagnosis and treatment projects and consumables shall be paid by the basic medical insurance pooling fund according to regulations, and no personal prepayment ratio shall be set; "Class B" medical items and consumables, the insured person pays 10% in advance, and some individuals who participate in the civil service subsidy (or 10% supplement) do not bear the burden; All "Class C" or "self-funded" medical treatment items and consumables shall be borne by the insured.
legal ground
People's Republic of China (PRC) social insurance law
Article 73 Social insurance agencies shall establish and improve business, financial, safety and risk management systems. Social insurance agencies shall pay social insurance benefits in full and on time. ;
Article 8
Social insurance agencies provide social insurance services, responsible for social insurance registration, personal rights and interests records, social insurance benefits payment and other work.
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.