what can be reimbursed by medical insurance mainly depends on the medical insurance catalogue. The medical insurance catalogue includes the medical insurance drug catalogue, the diagnosis and treatment project catalogue and the scope of medical service facilities catalogue. 1. List of medical insurance drugs: divided into Class A and Class B.. Drugs in the Class A catalogue can be fully included in the scope of reimbursement, and then reimbursed according to the prescribed proportion; Drugs in Category B need to be paid by individuals in a certain proportion, and the rest will be included in the scope of reimbursement, and then reimbursed according to the prescribed proportion. For example, drugs such as diet pills, hangover drugs and infertility treatment cannot be reimbursed. 2. Catalogue of diagnosis and treatment items: diagnosis and treatment items that are necessary for clinical diagnosis and treatment, safe and effective, and have appropriate expenses, and the charging standards have been set by the price department. For example, registration fee, medical record fee, beauty project and cosmetic project cannot be reimbursed. 3. Catalogue of medical service facilities: the service facilities provided by designated medical institutions and necessary in the process of receiving diagnosis, treatment and nursing. For example, ambulance, hospitalization escort fee, washing fee and recreational activities fee cannot be reimbursed.
Social Insurance Law of the People's Republic of China
Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
article 28 medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.
article 29 the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency, medical institutions and pharmaceutical trading 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.