What items can medical insurance reimburse?

According to the provisions of the Social Insurance Law, as long as it meets the standards of the basic medical insurance drug list, first aid and rescue medical expenses, diagnosis and treatment items and medical service facilities, it can be paid from the basic medical insurance fund in accordance with state regulations. Among them, the reimbursement scope of social medical insurance mainly includes the following points:

1. Reimbursement of basic medical insurance drugs. Both Class A and Class B drugs covered by basic medical insurance can be reimbursed.

2 reimbursement of basic medical insurance treatment projects, must be in accordance with the provisions of the state basic medical insurance treatment project scope to determine the basic medical insurance payment project scope. The diagnosis and treatment items that are part of the expenses paid by the basic medical insurance can be paid by the insured in advance and then paid in accordance with the provisions of the basic medical insurance.

3. Reimbursement of basic medical service facilities. The reimbursement scope of medical service facilities of the basic medical insurance includes the service facilities that the insured must live in the process of diagnosis and treatment, including bed fees for outpatient and emergency observation and bed fees for hospitalization. For some referral transportation expenses, emergency transportation expenses, infant incubator expenses, food incubator expenses, nursing expenses and escort expenses, the basic medical insurance fund cannot reimburse them.

First, the reimbursement process of medical insurance in different places:

1. First of all, you need a referral certificate from a hospital at or above the county level. Take the medical insurance in a small town as an example. If you want to go to a different place for medical treatment, you must first go to a hospital at or above the county level. There are usually county-level hospitals in the town, where doctors can issue referral certificates.

2. Stamp the social security window of the hospital. The social security window of a hospital is usually located at the toll gate. Take the referral certificate to the window, and the staff there will naturally know how to help you!

3. Go to the local social security bureau or social security office to register for out-patient treatment. Generally, there are social security offices in towns. Because it is a branch, it may be in an inconspicuous place.

4. After going out for treatment, take it back to the county social security bureau for reimbursement. After completing the above three steps, you can go to a hospital in a big city. When you have cured the invoice, medical book, social security card and household registration book, you can wait for the superior social security bureau to reimburse you.

Second, the medical insurance reimbursement process:

1. Original ID card or social security card;

2. The original disease diagnosis certificate issued by the designated medical institution;

3. Outpatient medical records, inspection, test results report and other medical materials;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

7. If it is an agent, you need to provide the original ID card of the agent.

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.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth 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.