What is the scope of social security medical care?

The scope of social security medical insurance reimbursement mainly includes basic medical insurance drugs, basic medical insurance diagnosis and treatment projects and basic medical service facilities. The following is the specific content of the scope of social security medical insurance reimbursement.

The basic medical insurance treatment project shall meet the following conditions:

1, clinical diagnosis and treatment must be safe and effective, and the cost is appropriate;

2. The charging standard shall be formulated by the price department;

3, by the designated medical institutions to provide medical services within the designated scope for the insured;

The social security card has the following functions:

1, personal social security related information records, electronic certificates and information inquiry, etc. ;

2. Record the insured's name, ID number, date of birth, gender, nationality, household registration and other basic information;

3, query my pension, unemployment, medical care, work injury and maternity insurance payment;

4. You can take the card to the hospital to see a doctor, settle the medical insurance personal account, and buy medicine at the pharmacy;

5 for medical care, unemployment, pension, work injury, maternity and other social security affairs;

6. Query the total amount of endowment insurance and medical insurance;

7. Handle social security affairs such as receiving pensions, registering for job hunting and unemployment, applying for unemployment insurance benefits, and vocational training.

To sum up, the reimbursement scope of medical service facilities in the basic medical insurance includes the living service facilities provided by designated medical institutions and necessary for the insured to receive diagnosis, treatment and nursing, mainly including the hospitalization bed fee or outpatient (emergency) observation bed fee.

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.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.