Medical insurance coverage:
1, reimbursement of basic medical insurance drugs: our country now divides drugs into three categories: A, B and C, of 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, medical treatment fees, etc. Expenses incurred by the insured in the process of medical treatment and nursing in designated medical insurance institutions;
3. Reimbursement of basic medical insurance diagnosis and treatment items: it must be a safe and effective diagnosis and treatment item, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.
To sum up, the examination expenses incurred during hospitalization can be reimbursed, but the expenses incurred during outpatient service cannot be reimbursed. Because the reimbursement scope of rural cooperative medical care must be the expenses incurred in hospitalization.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
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.