What are the reimbursement scope of Foshan Ping An Medical Insurance?

Legal analysis: The coverage of Ping An Buddha's medical insurance includes inpatient and outpatient chronic diseases, outpatient specific diseases and cancer special drugs.

1. Compensation for medical expenses borne by individuals within the scope of medical insurance catalogue: medical expenses within the scope of medical insurance catalogue for hospitalization of chronic diseases (including two parts: individual pays and individual pays).

2. Compensation for personal expenses outside the scope of medical insurance catalogue: medical expenses incurred by individuals outside the scope of medical insurance catalogue at their own expense.

3. Out-of-pocket drug compensation for specific diseases (tumors) in the basic medical insurance outpatient department: the insured applies to the insurance institution for treatment according to regulations, and after the treatment is approved to take effect, the insured treats specific diseases (tumors) in the outpatient department, uses malignant tumor treatment drugs and indications that have been considered by the insurance institution but not included in the medical insurance catalogue, and the compliance expenses incurred in seeing a doctor, purchasing drugs in a tertiary hospital designated by the insurance institution or purchasing drugs in a designated pharmacy.

4. Compensation for ultra-high medical expenses (expenses within the scope of medical insurance catalogue): compliant medical expenses within the scope of medical insurance catalogue after compensation for basic medical insurance, serious illness insurance and supplementary medical insurance in the insured year.

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.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.