The "three catalogues" of basic medical insurance include the catalogue of basic medical insurance drugs, the catalogue of diagnosis and treatment items and the standard of medical service facilities. The three catalogues are not static, but change, adjust and improve with the development of society and the improvement of people's living standards.
List of basic medical insurance drugs:
Refers to the basic medical insurance, industrial injury insurance and maternity insurance funds to pay the insured drug costs and strengthen the medical insurance medical service management policy basis and standards.
Directory of diagnosis and treatment items:
When the designated medical institutions of medical insurance provide medical services for the insured, the price department shall formulate the charging standards for clinical diagnosis and treatment, so as to standardize the diagnosis and treatment items of social basic medical insurance. In practice, it is determined by formulating basic medical insurance diagnosis and treatment items.
Standard of medical service facilities:
In the process of providing hospitalization and other medical services, the necessary medical service facilities and environment should be selected as the coverage of medical insurance. In practice, it is determined by formulating the standard of basic medical insurance service facilities. In order to standardize the scope of medical service facilities and payment standards, various provinces and cities have also formulated corresponding measures to ensure the basic medical needs of the insured.
In order to ensure the insured workers' demand for basic medical drugs, reasonably control medical expenses, standardize the management of basic medical insurance drugs and diagnosis and treatment, and ensure the healthy operation of the basic medical insurance system, the state and the province have formulated the Catalogue of Basic Medical Insurance Drugs, the Catalogue of Medical Treatment Projects for Urban Workers and the Project Scope of Medical Service Facilities for Urban Workers, which are referred to as "three catalogues" for short.
Compared with the "three catalogues", the medical expenses incurred by the insured are divided into three categories: one is the expenses directly included in the reimbursement scope; The other is the expenses that are included in the scope of reimbursement after the individual bears a certain proportion; The third category is the expenses that are not reimbursed by medical insurance and are all borne by individuals. Among them, the expenses incurred by using drugs are divided into Class A and Class B according to the basic medical insurance drug list, and drugs not in the list are self-funded drugs. Class A drugs are directly included in the scope of reimbursement and reimbursed in proportion; Class B drugs, 10% human albumin, etc. If the individual bears the expenses first, he shall bear 30% first, and then be reimbursed according to the prescribed proportion; Self-funded drugs are not reimbursed.
The expenses incurred in the use of diagnosis and treatment projects and service facilities are divided into three categories: projects directly included in the scope of reimbursement according to the Catalogue of Diagnosis and Treatment Projects of Basic Medical Insurance for Urban Employees and the Scope of Medical Service Facilities of Basic Medical Insurance for Urban Employees, projects that individuals bear a certain proportion first and then reimburse them in proportion, and projects that are reimbursed at their own expense. Items directly included in the scope of reimbursement shall be reimbursed according to the prescribed proportion; Individuals shall bear a certain proportion of the items to be reimbursed in proportion first. Individuals shall bear 10% and 15% first, and then be reimbursed in proportion. Self-funded medical or service facilities will not be reimbursed.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.