According to Shandong Province Urban and Rural Residents' Basic Medical Insurance Catalog and Shandong Province Employees' Basic Medical Insurance Catalog and other related documents, Shandong Province medical insurance reimbursement scope mainly includes the following aspects: 1. Basic drugs: refers to the medicines that are in line with the provisions of the national and provincial basic drug catalogs for treating, preventing, and diagnosing common and frequent diseases, as well as some rare diseases, etc. The basic drugs are not only used for the treatment of common diseases, but also for the prevention and diagnosis of some diseases. For basic drugs, Shandong Provincial Health Insurance has a higher reimbursement rate, generally between 85% and 90%.2. Commonly used medical treatment items: including hospitalization, surgical treatment, chemotherapy, radiotherapy, dialysis, etc., generally reimbursed within the range of 70% to 85%.3. High-value medical consumables: referring to disposable medical devices, consumables and high-value medical consumables used for medical treatment, therapy and rehabilitation. The reimbursement rate varies according to different types of medical consumables and equipment. It should be noted that each type of medical insurance reimbursement scope and standard has specific rules and conditions that need to be met when applying for reimbursement. In addition, Shandong Province has also implemented a hierarchical diagnosis and treatment system for primary medical institutions, providing a full reimbursement policy for some of the common diseases and chronic diseases carried out by hospitals at the county level and below, so as to provide a better quality of medical insurance services for the general public.
What channels are available for reimbursement of medical items and medicines that are not covered by Shandong's health insurance? For medical items and medicines that are not covered by Shandong's health insurance, they can generally be reimbursed through commercial insurance. In addition, Shandong has introduced a hybrid payment method of "medical insurance + commercial insurance", which allows for reimbursement from national or provincial medical insurance, as well as supplemental reimbursement through commercial insurance.
Shandong province medical insurance reimbursement scope covers a more comprehensive project, for the masses of medical protection to provide a better guarantee. However, it is important to note that when applying for reimbursement, you should strictly follow the relevant conditions and requirements to ensure that your rights and interests are protected.
Legal basis:
"Shandong Province urban and rural residents of the implementation of basic medical insurance measures" Article 12 of the basic medical insurance treatment should be in accordance with the medical insurance directory and fee standards, shall not exceed the standard payment of medical expenses.