Drugs included in the scope of basic medical insurance payments are divided into two categories: Class A and Class B. Class A drugs are those that are basically uniform throughout the country and can ensure the basic needs of clinical treatment. The costs of these drugs are covered by the basic medical insurance fund and are paid according to the basic medical insurance payment standards.
The catalog of Class B drugs is adjusted by provinces, autonomous regions and municipalities directly under the central government according to their own conditions. These drugs are first paid for by employees at a certain percentage before being included in the scope of the basic medical insurance fund and paid for according to the standard of payment of the basic medical insurance.
The following medicines are excluded from the basic medical insurance reimbursement scope: (1) the main role of nutritional tonic medicines; (2) part of the animal and animal organs that can be used as medicine, dried (water) fruit; (3) all kinds of wine preparations made of Chinese herbs and Chinese medicine tablets; (4) all kinds of medicines in the fruit-flavored preparation, oral effervescence; (5) blood products, protein products (special indications and first aid, rescue); (6) blood products, protein products (special indications and first aid, rescue); (7) blood products, blood products, protein products (special indications and first aid, rescue); (8) blood products, blood products, protein products (special indications and first aid, rescue), blood products, blood products (special indications and first aid, rescue), blood products (special indications and first aid, rescue). (except for special indications and first aid, rescue); (6) the social insurance administrative department stipulates that the basic medical insurance fund does not pay for other drugs.
Basic medical insurance diagnosis and treatment program should meet the following conditions: (1) clinical diagnosis and treatment must be, safe and effective, the cost is appropriate; (2) by the pricing department set the fees; (3) by the designated medical institutions for the insured to provide designated medical services within the scope of medical services.
The scope of diagnostic and therapeutic items for which the basic medical insurance pays part of the expenses is determined in accordance with the "Scope of Diagnostic and Therapeutic Items of Basic Medical Insurance" stipulated by the state. If the diagnostic and treatment items are within the catalog of diagnostic and treatment items paid by basic medical insurance, the insured person shall first pay out of pocket in accordance with the prescribed proportion, and then pay according to the provisions of basic medical insurance. The basic medical insurance fund will not pay for those within the catalog of diagnostic and therapeutic items that are not paid for by the basic medical insurance.
3. Reimbursement of basic medical service facilities
The reimbursement of basic medical insurance medical service facilities covers the living service facilities provided by the designated medical institutions, which are necessary for the participants in the process of receiving diagnosis, treatment and care, including inpatient hospitalization beds or outpatient (emergency) beds.
The basic medical insurance fund does not pay for the cost of living services and service facilities, including: (1) consultation (transfer) transportation fees, emergency vehicle fees; (2) air-conditioning fees, television fees, telephone fees, infant warming box fees, food warming box fees; (3) escort fees, nursing fees, cleaning fees, outpatient decoctions, (4) meals; (5) recreational activities and other special needs of the living costs. The following is a list of the expenses of these services.
The following ten items are not covered by medical insurance.
1, special medical expenses for organ and tissue transplants due to medical conditions, the cost of purchasing organs and tissues, and the use of anti-rejection drugs and immunomodulatory drugs beyond the scope of Zhenjiang City Employees' Medical Insurance Drug Reimbursement Scope;
2, work-related injuries and occupational diseases;
3, childbirth for female workers;
4, hooliganism and assaults;
5, alcoholism and drunkenness;5, and the use of alcohol and other drugs.5. Injuries caused by alcoholism;
6. Traffic accidents;
7. Intentional injuries caused by others;
8. Medical malpractice;
9. Cosmetic surgery and health checkups;