Legal basis: Article 41 of the Regulations on Basic Medical Insurance for Urban Workers in People's Republic of China (PRC).
The provincial labor and social security administrative department shall, in accordance with the relevant provisions of the state, determine the basic medical insurance drug list in conjunction with the planning, economy, trade, finance, health administration and drug supervision and management departments.
The provincial labor and social security administrative department shall, in accordance with the relevant provisions of the state, jointly with the planning, finance, health administration and drug supervision and management departments, determine the basic medical insurance diagnosis and treatment project directory, the scope of medical service facilities and payment standards.
The use of drugs, medical treatment projects and medical service facilities that are not included in the basic medical insurance coverage will not be paid by the overall fund.
What are the conditions for medical insurance reimbursement?
1. In order to obtain medical insurance reimbursement for medical behavior in designated institutions, first of all, the insured person needs to see a doctor or buy medicine in designated medical institutions and pharmacies stipulated by the basic medical insurance in order to obtain reimbursement, otherwise it cannot be reimbursed;
2. If it belongs to the social security catalogue, it is necessary to have medical treatment items or purchased drugs in the social security catalogue to be reimbursed, otherwise it cannot be reimbursed;
3. To reach the deductible standard, medical insurance reimbursement is required. First, the medical expenses incurred by the insured reach the deductible line stipulated by social security, and the part exceeding the deductible line can only be reimbursed within the limit, and the unified proportion is paid by the basic medical pooling fund.