Beijing medical insurance prescription management regulations

There are.

Under the guidance of the general spirit of the central government, the specific policies of each province, municipality directly under the central government and autonomous regions are slightly different. You can check the relevant policies of your province (municipality directly under the central government, autonomous region). The general principle: according to the provisions of the actual reimbursement. This provision is more complicated, the drug catalog (each province to develop their own) within the scope of the drug reimbursement, drugs outside the scope of the drug reimbursement or not reimbursement of a proportion. To put it simply: for example, heart bypass stents, with imported good, but only at the price of domestic reimbursement to you; globulin, normal use is not reimbursed, emergency reimbursement; bed costs, only according to the standard bed reimbursement, high-grade ward expenses out of pocket and so on.

Below is a list of Beijing's regulations for your reference

According to the "Beijing Municipal Publicly-funded Medical Care Management Measures" and the Beijing Municipal Health Insurance Affairs Management Center's relevant documents, combined with the actuality of the Ministry of the following regulations:

1. Retired cadres can only be in the designated contracted hospitals and self-selected a nearby hospitals (which must be the designated hospitals of Beijing Municipal Health Insurance). The hospital must be a designated hospital of the Beijing Municipal Health Insurance).

2. In case of referral due to medical condition, there must be a referral letter issued by the contracted hospital or the nearest hospital, otherwise the relevant medical expenses will not be reimbursed.

3. Patients who need to be resuscitated due to emergency conditions can go to any regular hospital nearby for resuscitation treatment, and after their conditions are stabilized, they will be transferred to the contracted hospital or the nearest hospital for further treatment. Reimbursement needs to be accompanied by a certificate of diagnosis of emergency treatment, a detailed bill of charges, and a receipt of charges to be stamped with the seal of emergency treatment. In case of emergency, tonics and proprietary Chinese medicines are not included in the scope of reimbursement.

4. For the reimbursement of medical expenses incurred in general outpatient clinics, it is necessary to attach: the bottom of the prescription for Beijing Medical Insurance, the fee receipt, the detailed list of examination and treatment fees, and the detailed list of medicines; for the reimbursement of medical expenses incurred in emergency clinics, it is necessary to attach: the bottom of the prescription for emergency clinics or the bottom of the prescription for Beijing Medical Insurance with the stamp of emergency clinics, the fee receipt, the detailed list of examination and treatment fees, and the detailed list of medicines; and for the reimbursement of expenses incurred in hospitalization. For reimbursement of expenses incurred in hospitalization, it is necessary to attach: settlement statement of hospitalization expenses, special receipt for Beijing hospitalization charges, certificate of discharge diagnosis, and detailed list of hospitalization medical expenses.

5. The scope of reimbursement for medicines shall refer to the relevant provisions of the scope of payment for medicines under the Beijing Municipal Basic Medical Insurance; the scope of reimbursement for diagnostic and therapeutic items, services and disposable medical consumables shall refer to the relevant provisions of the scope of payment for medicines under the Beijing Municipal Basic Medical Insurance.

6. Retired cadres who purchase medicines (excluding medicines used at over-limit level) must purchase medicines at designated retail pharmacies of Beijing Municipal Health Insurance with a special prescription for health insurance stamped with the seal of purchase of the contracted hospital or the nearest hospital, and the reimbursement must be accompanied by the prescription for purchase and the invoice of the designated retail pharmacy.

7. When the blue card retired cadres enjoying medical care need to use self-financed medicines due to their illnesses, they need to obtain a certificate of medication from the contracted hospital or the nearest hospital and send the certificate of medication to the Bureau's medical office after the hospital's Public Medical Office agrees to and stamps the certificate of medication, which will then apply for reimbursement from the Beijing Municipal Center for Medical Insurance Services, and then reimbursement will be given after approval. After each application is approved, the use is valid for three months. If you need to continue to use the medicine, you must apply again before the expiration date.

8, outpatient prescriptions for chronic diseases not exceeding seven days of medication, where suffering from hypertension, diabetes, coronary heart disease, chronic hepatitis, cirrhosis, tuberculosis, mental illness, cancer, cerebrovascular disease, prostate hypertrophy and other diseases, can be relaxed to no more than one month of medication; the medical clinic can only prescribe seven days of medication.

9, short-term to visit relatives abroad, need to report to the infirmary for the record, such as the need for medical treatment outside, only emergency medical expenses, reimbursement requirements in accordance with the relevant provisions of the Beijing Municipal Government; long-term residence in a different place, need to be filed by the Bureau of the Party Office, the Bureau of the infirmary agreed to a fixed local regular public hospitals, reimbursement requirements in accordance with the relevant provisions of the Beijing Municipal Government; travel abroad to visit relatives incurred medical expenses are not reimbursed. The medical expenses incurred while traveling abroad to visit relatives will not be reimbursed.

10, the use of "partially self-financed" medicines for retired cadres at the division level and below (based on the computer-printed list of medicines in the hospitals) is subject to the personal responsibility of the individual, in accordance with the standard implementation of 10% of Western medicines and 5% of proprietary Chinese medicines at their own expense.

11, in the examination, treatment programs, a single cost of more than 500 yuan (including 500 yuan) of medical materials are valuable medical materials, the use of valuable medical materials (including disposable medical equipment, disposable imported medical materials, etc.), the individual has to bear 15% of the total cost. The use of cardiac stents for retired cadres does not require personal responsibility.

12. When hospitalized, the reimbursement standard for ward bed fee is: no more than RMB 100 per person per day for ward bed fee for cadres enjoying medical care at the vice-ministerial level; no more than RMB 80 per person per day for ward bed fee for cadres enjoying medical care at the division level; and no more than RMB 40 per person per day for ward bed fee for cadres enjoying medical care at the division level and below. Those exceeding the above standard shall be reimbursed according to this standard, and those not reaching this standard shall be reimbursed according to the actual bed charge.

13, reimbursement of medical expenses time requirements: the expenses incurred in the month, try to reimbursement in the same month, the latest can not exceed the 28th of the next month. The reimbursement time in December and January of each year is in accordance with the time of reimbursement notified by the Beijing Municipal Health Insurance Affairs Management Center, which will be announced separately.

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