Paclitaxel albumin medical insurance is not included in the scope of reimbursement. According to national regulations, class B or class C drugs should pay 10% and 90% at their own expense, and class C drugs should pay their own expenses, while human albumin belongs to class C drugs. At the same time, except for special indications, first aid and rescue, nuclear magnetic resonance, CT, PET, medical equipment and materials used and purchased, as well as nutritional supplements, blood products and protein products cannot be reimbursed. In other words, reimbursement of medical expenses can only be reimbursed for Class A drugs. Domestic albumin paclitaxel is not in the medical insurance catalogue and cannot be directly reimbursed by medical insurance. It's a self-funded medicine.
Medical insurance reimbursement conditions are as follows:
1, the newly insured and re-insured employees who have stopped paying 1 year or more shall participate in the basic medical insurance according to law and pay for 6 consecutive months (excluding the overdue period), and enjoy the basic medical insurance benefits according to regulations;
2, continuous payment of less than 6 months, do not enjoy the basic medical insurance benefits;
3. If the payment is interrupted for less than one year, you will enjoy the treatment according to the regulations after re-insurance payment;
4, the interruption of payment personnel do not enjoy the basic medical insurance benefits during the interruption of payment.
The materials required for medical insurance reimbursement are as follows:
1, transfer certificate issued by the hospital in this city;
2. Take the transfer certificate issued by the hospital to the local and district social security offices (medical insurance offices) for the examination and approval of medical treatment in different places;
3. Original hospitalization invoice of designated hospitals in different places;
4, the original list of machine costs;
5. A valid copy of the inpatient medical record (the hospital seal is valid);
6. 1 copy of ID card.
To sum up, medical expenses reimbursement can only be reimbursed for Class A drugs, while paclitaxel albumin does not belong to Class A drugs and needs to be reimbursed at its own expense.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.