Expenses in the 1. directory: medical insurance can be reimbursed, which generally refers to "expenses in social security".
2. Off-catalog expenses: medical insurance is not reimbursed, such as some newly listed anticancer drugs, imported drugs, expensive innovative drugs, patented drugs, etc. And you need to pay for it yourself.
There are three main categories of medical insurance reimbursement catalogues, including drug catalogues, diagnosis and treatment catalogues and medical service facilities catalogues. Only the expenses in the catalogue can be reimbursed. If the medical expenses fall into these three categories, they can be reimbursed; If not, they can only pay for it themselves.
1. Drug List: The drug list of basic medical insurance refers to the drug list necessary to ensure the clinical treatment of insured employees, which is included in the basic medical insurance coverage. It is a way to manage the scope of basic medical insurance drugs. It mainly includes Class A and Class B drugs. Class A drugs are necessary for treatment, cheap and easy to use, and can be reimbursed 100%. Class B drugs are optional and easy to use, but the price will be slightly more expensive, generally 70%-80% will be reimbursed. However, some nourishing and health-care drugs are generally outside the drug list, such as diet pills and hangover drugs.
2. Catalogue of diagnosis and treatment: it mainly refers to items that are necessary for treatment and have definite curative effect, but are expensive, such as hemodialysis. But cosmetic surgery is not in the catalogue.
3. Catalogue of medical service facilities: necessary service setting fees in the process of diagnosis and treatment, such as bed fees. , but the escort fee and care fee are not in the catalogue and are not included.
Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).
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.