What are specifically included in the scope of medical insurance reimbursement?
Including medical insurance drug list, medical insurance diagnosis and treatment items and medical insurance service facilities.
First, the medical insurance drug list
The National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2020) contains 2,800 drugs, including western medicine 1.264, Chinese patent medicine1.365,438 (including 93 ethnic medicines) and 22/kloc-0 (including western medicine 654,438). Drugs are divided into Class A and Class B, 395 kinds of western medicine, 242 kinds of traditional Chinese medicine, and the rest are Class B drugs. During the agreement period, the drugs negotiated are paid according to Class B drugs. Class A drugs are necessary for clinical treatment, widely used and cheap, and are fully included in the medical insurance reimbursement. Class B drugs are drugs with good curative effect and higher price than Class A drugs. Some of these drugs need to be paid by individuals, and the rest are all included in the medical insurance reimbursement, and the reimbursement ratio is roughly 80%-90%.
Two, medical insurance diagnosis and treatment project directory
The diagnosis and treatment project refers to all kinds of medical technical service projects and the diagnosis and treatment projects using medical instruments, equipment and medical materials that meet the following conditions:
(1) Necessary, safe and effective clinical diagnosis and treatment projects with appropriate expenses;
(two) the price department has set the standard of diagnosis and treatment projects;
(3) the designated medical institutions for the insured medical services within the scope of diagnosis and treatment projects.
Ministry of Human Resources and Social Security, jointly with the relevant departments, is responsible for organizing the formulation of the scope of the national basic medical insurance diagnosis and treatment projects, and adopting the exclusion method to stipulate the scope of the diagnosis and treatment projects that the basic medical insurance does not pay the fees and the scope of the diagnosis and treatment projects that the basic medical insurance pays part of the fees. The basic medical insurance does not pay for medical treatment items, mainly those that are not necessary for clinical treatment and whose curative effect is uncertain, and those that belong to special medical services. The basic medical insurance covers part of the cost of medical treatment projects, mainly some necessary and effective clinical treatment projects that are easy to abuse or expensive.
Three. Directory of medical insurance service facilities
Medical service facilities refer to the life service facilities provided by designated medical institutions for the insured in the process of diagnosis, treatment and nursing. Facilities costs mainly include hospital bed fees and outpatient (emergency) hospital bed fees, and the basic medical insurance fund will not pay for living services and service facilities costs mainly include:
(1) outpatient and first aid (transfer) transportation expenses;
(2) Air conditioning fee, TV fee, telephone fee, baby incubator fee, food insulation fee, electric stove fee, refrigerator fee and compensation fee for public property damage;
(3) Escort fee, nursing fee, washing fee and outpatient decocting fee;
(4) meals;
(5) Hospitality and other special life service expenses.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 18 The state establishes a normal adjustment mechanism for basic pensions. According to the average wage increase and price increase of employees, the basic old-age insurance treatment level will be improved in a timely manner.
Nineteenth individuals across the overall regional employment, the basic old-age insurance relationship with my transfer, the cumulative payment period. When an individual reaches the statutory retirement age, the basic pension is calculated in stages and distributed uniformly. Specific measures shall be formulated by the State Council.