What is covered by health insurance?
Including the medical insurance drug catalog, medical insurance diagnosis and treatment program, medical insurance service facilities three.
One, the medical insurance drug catalog
National basic medical insurance, industrial injury insurance and maternity insurance drug catalog (2020) included in the 2800 kinds of drugs ***, of which the western medicine part of the 1,264, pCms part of the 1,315 (including ethnic medicine 93), the agreement period of negotiation of the drug part of the 221 (including western medicine 162, pCms 59). Drugs are managed in categories A and B, with 395 western medicines in category A, 242 pCms in category A, and the rest in category B. The negotiated drugs during the agreement period are paid in accordance with category B. The negotiated drugs during the agreement period are paid in accordance with category B. Drugs negotiated during the agreement period are paid in accordance with Category B. Category A drugs are those that are necessary for clinical treatment, widely used and less expensive, and are fully reimbursed by the medical insurance. Category B drugs are effective and more expensive than Category A drugs, which require individuals to pay a certain percentage out of their own pocket, and the remainder is fully reimbursed by the health insurance program, with a reimbursement rate of roughly 80% to 90%.
Second, the medical insurance diagnosis and treatment project catalog
Diagnosis and treatment project refers to a variety of medical technology labor projects and the use of medical instruments, equipment and medical materials for diagnosis and treatment projects in accordance with the following conditions:
(1) Clinical diagnosis and treatment is necessary, safe and effective, and the cost of appropriate diagnosis and treatment projects;
(2) by the price department has set the fees for diagnosis and treatment projects;
(3) by the price department has established a fee for diagnosis and treatment projects.
(3) diagnostic and therapeutic items within the scope of designated medical services provided by the designated medical institutions for the insured.
The Ministry of Human Resources and Social Security, in conjunction with the relevant departments, is responsible for organizing and formulating the scope of diagnostic and therapeutic items for the national basic medical insurance, and adopting the exclusion method to stipulate the scope of diagnostic and therapeutic items for which basic medical insurance does not pay and the scope of diagnostic and therapeutic items for which basic medical insurance pays for a portion of the costs. Diagnostic and treatment items that are not paid for by basic medical insurance are mainly those that are not necessary for clinical treatment, those whose effects are uncertain, and those that belong to special medical services. Basic medical insurance to pay part of the cost of treatment programs, mainly some of the clinical diagnosis and treatment is necessary, the effect of certain but easy to abuse or expensive diagnosis and treatment programs.
Third, the medical insurance service facilities catalog
Medical service facilities refers to the life service facilities provided by the designated medical institutions in the process of diagnosis, treatment and care of the insured. The costs of facilities mainly include inpatient beds and outpatient (emergency) beds, and the costs of living services and facilities that are not paid by the basic medical insurance fund mainly include:
(1) consultation (referral) transportation fees, emergency vehicle fees;
(2) air-conditioning fees, television fees, telephone fees, infant incubators, food insulation, electric stoves, refrigerators, and damage to public property Compensation fee;
(3) Accompanying fee, nursing fee, cleaning fee, outpatient medication fee; (4) Meal fee; (5) Recreational activity fee and other special needs living service fee.
Legal basis: The Social Insurance Law of the People's Republic of China
Article 18 The State establishes a mechanism for normal adjustment of basic pensions. The level of basic pension insurance benefits shall be raised at the appropriate time in accordance with the growth of the average wage of employees and the rise in prices.
Article 19 If an individual is employed across the integrated region, his or her basic pension insurance relationship shall be transferred with him or her, and the years of contribution shall be cumulative. When an individual reaches the legal retirement age, the basic pension is calculated in sections and paid uniformly. The specific measures shall be prescribed by the State Council.