According to Article 28 of the Social Insurance Law of the People's Republic of China, medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Expanded content:
Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the Workers' Compensation Insurance Fund;
(2) those that should be borne by a third person;
(3) those that should be borne by the public ****health;
(4) those that seek medical treatment outside of China.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party does not pay or if the third party cannot be identified, the basic medical insurance fund shall pay first. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.
The outpatient clinic can not be reimbursed, the medical insurance reimbursement classification as well as the items included are as follows:
1, general medical insurance. It mainly includes outpatient costs, medicine costs, examination costs and so on.
2, hospitalization insurance. It mainly covers daily hospitalization fee, cost of utilizing hospital equipment, surgery cost, medicine cost and so on.
3. Surgical insurance. Provides for all expenses incurred due to necessary surgery required by the patient.
4. Comprehensive medical insurance. Its cost coverage includes all costs of medical treatment and hospitalization and surgery, etc.
5, special disease insurance. Certain special diseases often bring the patient a catastrophic cost payment, the average resident family can hardly afford. Examples include cancer and heart disease. Provide coverage for policyholders of major diseases, can be a single, such as malignant tumors, or even malignant tumors in a certain number of cancers.
Expanded information: