Medical insurance reimbursement is limited in scope. Only medical expenses within the scope of medical insurance regulations can be reimbursed. The reimbursement scope of medical insurance can be divided into three major catalogs, the details are as follows: (1) Drug catalog. The medicines we prescribe in the hospital must be specified in the medical insurance catalog in order to be reimbursed. The drugs that can be reimbursed by medical insurance can be divided into the following two categories: 1) Class A drugs: drugs that are necessary for clinical treatment and are cheap and easy to use. The state has unified regulations and can be reimbursed at a 100% rate. 2) Category B drugs: Drugs that are optional, easy to use but slightly expensive, are generally reimbursed at a rate of 70%-80%. However, it should be noted that nourishing and health-care drugs such as weight-loss drugs, hangover drugs, and some special drugs and imported drugs are not included in the drug catalog and cannot be reimbursed. (2) Directory of diagnosis and treatment items. The catalog of diagnosis and treatment items mainly includes items that are necessary for treatment and have certain effects but are expensive, such as hemodialysis and bone marrow transplantation. It must be noted that medical items that are mainly unnecessary, have uncertain effects, or belong to special needs, such as beauty and plastic surgery, are not covered by reimbursement. (3) Directory of medical service facilities. The catalog of medical service facilities refers to the cost of service facilities necessary during the treatment process, such as bed fees. However, non-essential service facilities such as hospitalization fees, nursing fees and recreational activity fees cannot be reimbursed.
Legal basis:
"Social Insurance Law of the People's Republic of China"
Article 23 Employees shall participate in employee basic medical insurance, which shall be provided by the employer Units and employees must pay basic medical insurance premiums together in accordance with national regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.
Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.