First, the difference between medical insurance and self-funded drugs:
The difference between paying with medical insurance and paying at my own expense is that I spend money at my own expense, and the medical insurance card is not reimbursed, and 75% to 80% of the expenses can be reimbursed for hospitalization and medicine purchase.
Self-funded refers to medical expenses that are not included in the scope of basic medical payment; Using drugs outside the basic medical insurance drug list; The use of basic medical insurance treatment projects, medical expenses of some treatment projects will not be paid; Medical expenses exceeding the payment standard of basic medical insurance medical service facilities; And the expenses incurred by medical service facilities that are stipulated not to be paid.
Medical insurance payment refers to the medical expenses that employees use to pay for the basic medical insurance pooling fund Qifubiaozhun below and insufficient outpatient account payment (excluding enterprise employees at present); When the basic medical insurance co-ordination fund and medical treatment for major diseases (i.e. medical assistance) are subsidized, individuals will pay part of the medical expenses in proportion.
2. Which pharmacies can use medical insurance cards?
In order to fully implement the livelihood of the provincial government in 20 19, improve the multi-level medical security system, improve the medical security level of the insured people in Yuecheng District, and standardize the medical management of chronic diseases outpatient service, Shaoxing Medical Insurance Bureau, together with the Municipal Health and Health Commission, the Market Supervision Bureau and the Finance Bureau, formulated the Implementation Plan of the Chronic Diseases Outpatient Security System for Urban and Rural Residents. From July 1 day, citizens can buy medicines directly at the designated pharmacies in the city with their medical insurance cards. There are 83 qualified designated retail pharmacies in Yuecheng District, including Zhenyuan, Hualian, Huatong, Huayu and ordinary people.
The New Deal for Chronic Diseases covers the insured persons of the basic medical insurance for urban and rural residents in the city, and the diseases include hypertension, diabetes, tuberculosis, coronary heart disease, bronchial asthma, chronic kidney disease, chronic obstructive pulmonary disease, chronic liver disease, Parkinson's disease, rheumatoid arthritis, Alzheimer's disease and schizophrenia.
In a medical insurance year, if the insured persons of urban and rural residents in Yuecheng District are treated in chronic disease clinics, the proportion of reimbursement for medical treatment in the city's primary medical and health institutions will increase from 50% to 60%, and the reimbursement will be made in designated retail pharmacies 15%. The cumulative net reimbursement limit of the insured in the chronic disease outpatient service (including other disease outpatient service and emergency service) of the designated medical institution was increased from 800 yuan to 1 000 yuan. Among them, last year's effective signing of the insured, poor people, low-income objects, low-income marginal objects, poor objects caused by illness, children in distress who enjoy basic living expenses, and those who hold the "People's Republic of China (PRC) Disabled Persons' Card" and have a disability level of more than two are the key special care targets. The above four categories of personnel buy 40% of prescription drugs for chronic diseases in designated retail pharmacies, and go to chronic disease clinics (including emergency departments for other diseases) in designated medical institutions.
At present, there are 5,574 kinds of chronic diseases drugs traded online on the provincial medical device procurement platform, which have all been included in the scope of chronic disease outpatient drugs for urban and rural residents. Moreover, according to the needs of patients' illness, designated medical institutions can extend the dosage of medical insurance for chronic diseases from the original 4 weeks to 12 weeks, which is convenient for ordinary people to seek medical treatment and purchase medicines.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.