According to the regulations of Shiyan Medical Insurance Bureau, the reimbursement scope of residents' medical insurance outpatient service mainly includes basic drugs, western medicine, Chinese medicine, diagnosis and treatment items, etc. Among them, essential drugs refer to drugs listed in the national and provincial essential drugs list and uniformly adjusted and used in accordance with the prescribed payment standards; Western medicine and traditional Chinese medicine need to meet the approval and registration requirements of relevant laws and regulations before they can be included in the scope of reimbursement. In addition to drugs, diagnosis and treatment projects are also one of the reimbursement areas for outpatient services. Common diagnosis and treatment items include various tests, examinations, treatments and operations. However, for some voluntary behaviors such as plastic surgery and physical examination, medical insurance will not be reimbursed. When residents' medical insurance outpatient reimbursement, the proportion of different types of medical expenses reimbursement is not the same. Take essential drugs as an example, the reimbursement rate of such drugs is 100%, while western medicine, traditional Chinese medicine and diagnosis and treatment projects are given different reimbursement rates according to different situations.
How to determine the reimbursement scope of Shiyan residents' medical insurance outpatient service? Shiyan Medical Insurance Bureau will formulate the specific scope of reimbursement according to the relevant regulations of the state and province, which will specify which drugs or medical treatment items can be reimbursed. Therefore, before seeing a doctor, patients can consult with doctors or hospitals whether they are included in the scope of reimbursement, so as to better budget for treatment and expenses.
Understanding the policies and standards related to the reimbursement scope of Shiyan residents' medical insurance outpatient service will help patients to better choose their own treatment plan, understand the specific situation of related expenses, and make more informed decisions. At the same time, when using medical insurance, we also need to abide by relevant regulations and earnestly safeguard the legitimate rights and interests of ourselves and society.
Legal basis:
"People's Republic of China (PRC) Medical Insurance Law" Article 25 The sources of financing for the basic medical insurance fund include individual contributions and financial subsidies for basic medical insurance.