How to directly reimburse medical insurance for diabetes taking medicine

Insured residents who have handled chronic diseases (diabetes) in outpatient clinics can settle accounts immediately if the outpatient medical expenses in designated medical institutions meet the requirements.

1. What are the reimbursement scopes of social security and medical insurance?

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.

1, drug reimbursement for basic medical insurance

The types of drugs in China can be mainly divided into Class A, Class B and Class C. The waist circumference of Class A is basically included in the scope of medical insurance funds and reimbursed according to certain standards. 80% of Class B drugs are reimbursed, and the other 20% are paid at their own expense; Class C drugs are self-sufficient drugs and will not be reimbursed.

The following drugs do not belong to the basic medical insurance reimbursement scope:

(1) drugs with nourishing and strengthening effects;

(2) Some animals and animal organs and dried fruits that can be used as medicine;

(3) Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces;

(4) Fruity preparations and oral effervescent agents in various medicines;

(5) Blood products and protein products (except for special indications and first aid and rescue);

(six) other drugs that are not paid by the basic medical insurance fund as stipulated by the administrative department of social insurance.

2, the basic medical insurance treatment project 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 should be appropriate;

(2) The price department has set the charging standard;

(3) within the scope of designated medical services provided by designated medical institutions for the insured.

3. Reimbursement of basic medical service facilities

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.

Two, diabetes medical insurance reimbursement ratio policy:

First, if the medical expenses are in the range of 0-40 thousand yuan, then the medical insurance can be reimbursed about 85%.

Second, if the medical expenses are 40,000-80,000 yuan, then the medical insurance can be reimbursed by about 90%.

Third, if the medical expenses are more than 80,000 yuan, then the medical insurance can be reimbursed by about 95%. 、

legal ground

Social insurance law

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

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.