It is understood that the basic medical insurance "three catalogs", that is, "basic medical insurance drug catalog", "basic medical insurance service facilities catalog", "basic medical insurance diagnosis and treatment items catalog".
1, "Basic Medical Insurance Drug Catalog"
The scope of basic medical insurance medication is managed through the development of the "Basic Medical Insurance Drug Catalog".
The medicines included in the Medicines Catalog shall be those that are clinically necessary, safe and effective, reasonably priced, convenient to use, and guaranteed by the market, and shall meet one of the following conditions:
(1) medicines contained in the Chinese Pharmacopoeia of the People's Republic of China (current edition);
(2) medicines in compliance with the standards issued by the State Pharmaceutical Supervision and Administration Department;
(3) medicines that meet the standards issued by the State Pharmaceutical Supervision and Administration Department. p>(3) Drugs officially imported with the approval of the State Drug Administration.
The following medicines cannot be included in the scope of basic medical insurance:
(1) medicines that mainly play the role of nutritional tonic;
(2) animals and animal organs, dried (water) fruits that can be partially used as medicines;
(3) all kinds of liquor preparations made from Chinese herbal medicines and Chinese herbal medicinal tablets;
(4) fruity preparations of all kinds of medicines and oral effervescent preparations;
(5) blood products and protein products (except for special indications and first aid and rescue);
(6) other medicines that are not payable by the basic medical insurance fund as stipulated by the social insurance administrative department.
The Drug List is divided into "Class A List" and "Class B List".
The medicines in the "Class A List" are those that are necessary for clinical treatment, widely used, have good efficacy, and are low-priced among similar medicines, and the "Class A List" is uniformly formulated by the State, and may not be adjusted by localities.
The medicines in the "Category B List" are those that can be selected for clinical treatment, have good therapeutic effects, and are priced slightly higher than those in the "Category A List" in the same category, which is formulated by the State and not adjusted by localities.
The "Class B List" is formulated by the state and can be adjusted appropriately by each coordinating region, and the sum of the number of varieties to be increased and decreased shall not exceed 15% of the total number of drugs in the "Class B List" as stipulated by the state.
The "Drug Catalog" is in principle adjusted every two years, and the "Drug Catalog" of each province, autonomous region and municipality directly under the central government is also adjusted accordingly.
2. Basic Medical Insurance Service Facilities
Basic medical insurance medical service facilities refer to the living service facilities provided by designated medical institutions, which are necessary for the insured persons in the process of receiving diagnosis, treatment and nursing care, and mainly include inpatient hospitalization bed fees or outpatient (emergency) observation bed fees.
The costs of living service items and service facilities that are not paid by the basic medical insurance fund mainly include:
(1) transportation fee for consultation (referral), emergency vehicle fee;
(2) air-conditioning fee, TV fee, telephone fee, baby warmer fee, food warmer fee;
(3) escort fee, nurse fee, cleaning fee, and outpatient medicine decoction fee;
(4) Meals;
(5) Recreational activities and other special needs living services.
3, "Basic Medical Insurance Diagnostic and Treatment Program Catalog"
Basic medical insurance diagnostic and treatment programs should meet the following conditions:
(1) Clinical diagnosis and treatment must be necessary, safe and effective, and the cost is appropriate;
(2) Fees and charges have been set by the price department;
(3) The designated medical institutions provide medical services for the participants. medical institutions for the participants within the scope of the designated medical services.
The scope of diagnostic and treatment items for which the basic medical insurance pays part of the cost is determined in accordance with the Scope of Diagnostic and Treatment 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 for by the basic medical insurance, the insured person shall first pay out of pocket in accordance with the prescribed proportion, and then pay in accordance with the provisions of the basic medical insurance.