What do you mean inside and outside the medical insurance catalogue?

The meaning of medical insurance directory inside and outside:

1, the medical insurance catalogue refers to the money we spend on going to the hospital for medical treatment, and medical insurance can be reimbursed, which generally refers to "social security expenses";

2. The medical insurance catalogue refers to the money we spend on going to the hospital to see a doctor. Medical insurance is not reimbursed, such as some newly listed anticancer drugs and imported drugs, which need to be paid by themselves. There are three catalogues of medical insurance: medicine catalogue, diagnosis and treatment catalogue and service facilities catalogue.

Medical insurance coverage:

1, drug reimbursement for basic medical insurance

Our country now divides drugs into three categories: A, B and C, among which A drugs are within the scope of medical insurance, so medical insurance can only reimburse A drugs, and B and C drugs cannot be reimbursed;

2. Reimbursement of basic medical service facilities

This reimbursement scope mainly refers to bed fees, first-aid bed fees, consulting fees, etc. Expenses incurred by the insured in the process of diagnosis, treatment and nursing in designated medical insurance institutions;

3, the basic medical insurance treatment project reimbursement

It must be a safe and effective diagnosis and treatment, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.

To sum up, there are three main categories of medical insurance reimbursement catalogues, namely, drug catalogue, diagnosis catalogue and medical service facilities catalogue. 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.

Legal basis:

Article 26 of People's Republic of China (PRC) Social Insurance Law

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; 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.

Article 28

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.