What does medical insurance cover?

1. basic medical insurance reimbursement drugs 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 are not covered by the basic medical insurance reimbursement: (1) drugs that mainly play a nourishing role; (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. Reimbursement of basic medical insurance diagnosis and treatment items should meet the following conditions: (1) Clinical diagnosis and treatment must be safe and effective with appropriate expenses; (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 basic medical insurance medical service facilities includes the living service facilities provided by designated medical institutions and necessary for the insured to receive diagnosis, treatment and nursing, mainly including inpatient bed fees or outpatient (emergency) observation bed fees. "Detailed Rules for the Implementation of the Social Insurance Law of People's Republic of China (PRC)" Article 8 If the medical expenses incurred by the insured in the agreed medical institutions meet the standards of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities, they shall be paid by the basic medical insurance fund in accordance with state regulations. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.

Legal objectivity:

"People's Republic of China (PRC) Social Insurance Law" Article 26 The treatment standards of 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. Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, standards of medical service facilities and medical expenses for emergency rescue, and shall be paid from the basic medical insurance fund in accordance with state regulations. "People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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.