Legal analysis: medical insurance reimbursement program
1, general medical insurance
1, including outpatient costs, medicine, inspection costs, etc.
2, hospitalization insurance daily hospitalization fees, the use of hospital equipment, surgical costs, medical costs, etc.
3, surgical insurance to provide all the costs incurred due to the patient needs to do the necessary surgery < /p>
4. Comprehensive medical insurance covers all costs of medical treatment and hospitalization and surgery
Legal basis: "Regulations on Basic Medical Insurance for Urban Workers of the People's Republic of China"
Article 41: The provincial administrative department of labor security shall, in accordance with the relevant provisions of the State, determine the basic medical insurance drug catalogue in conjunction with the departments of planning, economic and trade, finance, health administration, and drug supervision and management. Medical Insurance Drug Catalog. The provincial labor security administrative department, in accordance with the relevant provisions of the State, in conjunction with the planning, finance, health administration, drug supervision and management departments to determine the basic medical insurance catalog of diagnostic and therapeutic items, the scope of medical service facilities and payment standards. The use of drugs, diagnostic and treatment items, medical service facilities not included in the scope of basic medical insurance, the cost of the integrated fund shall not be paid.
Article 42 The provincial labor security administrative department, in accordance with the relevant provisions of the State, in conjunction with the health administration and drug supervision and management departments to formulate the basic medical insurance designated medical institutions management methods. Provincial labor security administrative departments in accordance with relevant state regulations, in conjunction with the drug supervision and management departments to formulate the basic medical insurance designated pharmacies management methods. The labor security, health administration and drug supervision and management departments implement dynamic management of the qualifications of designated medical institutions and designated pharmacies.
Article 43 The labor security, health administration, drug supervision and management departments and social insurance agencies determine the designated medical institutions and designated pharmacies based on the management methods of designated medical institutions and designated pharmacies, according to the principles of both Chinese and Western medicines, and taking into account the community, specialized and comprehensive medical institutions, and facilitating the medical treatment of the insured, and make them known to the insured.
Article 44 When a patient uses his personal account, he may seek medical treatment and purchase medicines at any designated medical institution and designated pharmacy. Where medical expenses are required to be paid by the integrated fund, the patient shall go to the designated designated medical institution.
Article 45 The unified fund pays for medical expenses, and in accordance with the principle of total control, the total prepayment system may be implemented for settlement. The social insurance administrative organization may regulate the amount of prepayment to the unified fund according to the quantity and quality of medical services provided by the designated medical institutions and the protection of the legitimate medical rights and interests of the insured.
Article 46 The fixed-point medical institutions and fixed-point pharmacies shall comply with the provisions of the state and the province of medicine and health and basic medical insurance, shall not in any way harm the legitimate medical rights and interests of the insured. The fixed-point medical institutions must inform the patient about the medical services and charges detailed information.
Article 47 The charges for basic medical services shall be formulated and revised by the provincial labor security and price administration departments in conjunction with the health administration and finance departments, and reported to the provincial government for approval. The price of basic medical insurance drugs shall be in accordance with national regulations on drug pricing. Violation of the basic medical service program fee standards and drug prices, the basic medical insurance fund accounts do not pay excessive medical fees.