(1) What is the basic medical insurance system?

The basic medical insurance system is an important part of the social security system in China. It is a social and economic system enforced by the state through laws and regulations. Employers and employees jointly participate in the payment and set up funds to ensure the basic medical needs of employees.

(2) What are the characteristics of the basic medical insurance system?

It is universal, economical and compulsory. Broadly speaking, all employers and their employees, whether state organs, social organizations, enterprises and institutions (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, private non-enterprise units, owners and their employees of individual economic organizations), are all within the basic medical insurance coverage. * * * Saving means that after all employers and their employees pay the basic medical insurance premiums according to regulations, once they get sick, the medical expenses will be paid by the medical insurance fund according to a certain proportion. Therefore, the medical expenses incurred by the insured are not linked to the amount paid by the insured and the unit, and the risks arising from illness are shared by all insured units and the insured. Compulsory means that according to the policy, all urban employers and employees must participate in basic medical insurance, which is different from any voluntary behavior of commercial insurance.

(3) What is the basic idea of establishing the basic medical insurance system for urban workers?

According to the needs of establishment and the requirements of promoting the reform of state-owned enterprises, and according to the basic national conditions of our country at this stage, the basic idea of this system reform is "low level, wide coverage, burden on both sides, and combination of unified accounts" The so-called "low level" is the level of basic medical insurance, which must be adapted to the development level of China's productive forces and fully consider the actual affordability of finance and enterprises. In other words, the level of basic medical insurance can only be determined according to the possibility, not according to the need, and can only provide basic medical security that finance and enterprises can bear. The so-called "wide coverage" means that all units and employees should participate as much as possible, which is the requirement of the law of large numbers in social insurance. Without a certain coverage, the functions of medical insurance such as mutual assistance, balanced burden, overall adjustment and risk diversification cannot be realized. The so-called "sharing" means that the basic medical insurance premium is paid by both the employer and the employee. It is necessary to change the drawback that the medical expenses of employees are borne by the state and enterprises in the free and labor insurance medical care system, and establish a mechanism in which employers and employees pay the same fees. This is not only conducive to expanding the sources of medical insurance funds, but also conducive to breaking the pot of medical insurance and enhancing the awareness of employees to protect themselves and save medical expenses. The so-called "unified account combination" means that the basic medical insurance system combines social pooling with individual accounts, which is a social medical insurance system. The implementation of this method can not only give play to the accumulation of individual medical accounts, enhance the awareness of individual self-protection and saving medical expenses, but also give play to the mutual assistance role of social pooling medical funds to solve the large medical risks of units and employees.

(4) What are the principles of the basic medical insurance system?

The level of basic medical insurance should be compatible with the economic development level of our city and the affordability of finance, employers and employees; All employers and their employees in cities and towns should participate in basic medical insurance and implement territorial management; The basic medical insurance premium shall be paid by both the employer and the employee, so as to make a balance between income and expenditure; The basic medical insurance fund combines social pooling with individual accounts.

(5) Why is the basic medical insurance not fully reimbursed for medical expenses, but reimbursed within the scope of medical insurance according to the prescribed proportion, and not reimbursed in absence?

At present, the reform of China's medical insurance system is mainly to solve the basic medical needs of urban workers, which is determined by China's economic development level and the affordability of finance, enterprises and individuals. According to China's current level of productivity development, employees' basic medical insurance benefits can only be very low, and only basic medical insurance can be provided. In terms of the payment level and treatment of basic medical insurance, it can neither fully take care of the existing medical consumption demand nor compare with the medical insurance level in developed countries. Specific to the level of payment, it can only be determined according to the affordability of finance and enterprises, and it is impossible to set it too high; If the determined payment level is too high, the enterprises with poor efficiency cannot pay, and the enterprises with good efficiency are unwilling to pay because of too many financial subsidies, and the national finance is also unbearable. Specific to the basic medical insurance treatment level, can only be determined according to the fund's affordability, and can not fully take care of the excessive medical consumption needs of a few people, resulting in the basic medical insurance fund overruns, affecting the basic medical needs of the vast majority of insured employees. Therefore, the basic medical insurance can only be "basic" at present, that is, medical expenses within the scope of medical insurance can be reimbursed according to regulations, and those outside the scope of medical insurance should be borne by themselves.

II. Insurance and Payment

(six) which units and employees must participate in the basic medical insurance?

According to the Interim Provisions on the Basic Medical Insurance for Urban Workers in Xuchang City, all urban departments, provincial units, foreign institutions stationed in Xu, all municipal organs, institutions, social organizations, private non-enterprise units, state-owned enterprises, collective enterprises, foreign-invested enterprises, joint-stock enterprises, joint-stock cooperative enterprises, private enterprises and other units and their employees must participate in the basic medical insurance directly under the municipal government. Owners of urban individual economic organizations and their employees and urban flexible employees should also participate in basic medical insurance.

(7) How do employers and their employees participate in basic medical insurance?

The basic medical insurance shall be subject to territorial management, and the employing unit shall go through the medical insurance registration formalities at the municipal medical insurance agency within 30 days after obtaining the business license or being approved for establishment. When handling the insurance registration procedures, you should fill in the "New Social Insurance Insurance Declaration Form" and "Xuchang Medical Insurance Insured Unit Registration Form", affix the official seal of the unit, and provide the following documents and materials:

(1) industrial and commercial business license, certificate of approval of the establishment of the unit, and certificate of legal person of the institution (both original and photocopy are acceptable);

(1) Organization Uniform Code Certificate issued by the national quality and technical supervision department (original and two copies);

(3) The full name and bank account number of the company's bank.

When employing new employees, the employing unit shall fill in the Application Form for New Employees of Social Insurance in Xuchang City, bring the labor contract or the letter of introduction of personnel within 30 days after employment, prepare this card, and go through the registration formalities with the municipal medical insurance agency.

(8) How do employers and their employees pay the basic medical insurance premium?

The basic medical insurance premium shall be paid by the employer and individual employees. The employer shall pay 6% of the total wages of employees in the previous year; On-the-job employees pay 2% of their salary income in the previous year, which is withheld and remitted by the employer from the employees' salary; Retirees do not pay the basic medical insurance premium. The basic medical insurance premium is generally withheld and remitted by the entrusted bank and levied on a monthly basis.

(9) How do urban flexible employees participate in the basic medical insurance and pay the fees? What medical insurance benefits do you enjoy?

Flexible employment personnel to participate in the basic medical insurance, should carry my ID card, urban household registration book or temporary residence permit, street and community labor and social security service institutions employment certificate and other materials, to the city employment service center in accordance with the provisions of the insurance procedures.

Flexible employment personnel to participate in the basic medical insurance, only to build a unified fund, not to build a personal account. The basic medical insurance premium is based on the average monthly salary of employees in this city last year, and is paid at 70% of the contribution rate of the insured units of basic medical insurance (the current ratio is 4.2%) (only the overall fund part is paid, and the personal account part is not paid). The payment method can be annual payment, which must be paid one month in advance.

Flexible employees who participate in medical insurance for the first time and enjoy medical insurance benefits will be given a waiting period of six months, that is, after six months of continuous payment, they can enjoy basic medical insurance and medical insurance benefits for serious illness relief.

Flexible employees should participate in medical insurance for serious illness relief while participating in basic medical insurance.

Flexible employees who participate in medical insurance for the first time and pay for more than 2 years (including 2 years) continuously meet the conditions of severe chronic diseases and enjoy medical treatment for severe chronic diseases according to regulations.

(ten) when to declare the basic medical insurance payment base? How to determine?

The employing unit shall declare the salary base for the next medical insurance year for all employees in April each year and the retirement expenses for its retirees in the previous year. When reporting, you need to bring the employee salary roster, financial statements and other materials of the unit in the previous year 12 months. The total wages of employees are calculated according to the statistical caliber, and the retirement fee does not include welfare subsidies such as transportation fees, books and newspapers fees, and heating fees.

If the wage income of employees in the previous year was lower than 60% of the average wage of employees in this Municipality, 60% of the average wage of employees in this Municipality shall be the reporting base; If it is higher than 300% of the average wage of employees in this Municipality in the previous year, 300% of the average wage of employees in this Municipality in the previous year shall be the reporting base. If the insured unit fails to declare as required, the payable amount shall be determined according to 1 10% of the unit's annual payment.

The employer shall truthfully declare the basic medical insurance payment base, and the administrative department of labor and social security will punish those who make false reports or conceal them in accordance with the Provisional Regulations on the Collection and Payment of Social Insurance Fees.

(eleven) how to stipulate the minimum payment period of basic medical insurance for employees and flexible employees of employers? What if the payment period is not enough when you retire?

The minimum payment period system shall be implemented for employees of the employing unit to participate in the basic medical insurance. 1999 65438+Feb. 3 1 The length of service of the employees who joined the work is regarded as the payment period, and the time when the medical insurance premium was actually paid after 2000 65438+1Oct. 3 1 is the actual payment period. When an employee reaches the statutory retirement age, it is deemed as the payment period plus the actual payment period. Only when male employees have reached more than 25 years and female employees have reached more than 20 years can they enjoy the medical insurance benefits for retirees.

Flexible employees to participate in the basic medical insurance to implement the minimum payment period and the actual payment period system. The minimum payment period is not less than 30 years for men and 25 years for women, and the actual payment period is not less than 10 years. Flexible employment of men over 60 years of age, women over 50 years of age, in line with the provisions of the minimum payment period and the actual payment period, no longer pay the basic medical insurance premiums, according to the provisions of the basic medical insurance fund for retirees to enjoy the treatment.

If the insured reaches the statutory retirement age, but does not reach the minimum payment period and the actual payment period, it shall continue to pay the basic medical insurance premium until it reaches the prescribed payment period and enjoy the basic medical insurance benefits for retirees in accordance with the regulations.

(12) The basic medical insurance premiums owed by employers and flexible employees?

Medical insurance implements the principle of equal rights and obligations, and employers and flexible employees must pay the basic medical insurance premium in full and on time.

(1) If the employer fails to pay the medical insurance premium, the municipal medical insurance agency may freeze the allocation of the medical expenses of the employees of the unit from the overall fund, and suspend the transfer of the employees of the unit to personal accounts next month, except for the overdue payment and the overdue payment, and then transfer to the unit according to the regulations. Units that refuse to pay medical insurance premiums shall be punished by the administrative department of labor security in accordance with the relevant provisions of the State Council's Provisional Regulations on the Collection and Payment of Social Insurance Fees and Basic Medical Insurance.

(2) Flexible employees participating in medical insurance should pay fees continuously. If the basic medical insurance premium is not paid, the basic medical insurance benefits will be suspended from the month of default.

If the basic medical insurance premium is unpaid for less than 3 months, from the date of normal payment, the basic medical insurance premium will be paid back and the basic medical insurance benefits will be restored after an additional fine of 2‰ is charged according to the regulations.

If the basic medical insurance premium is unpaid for more than 3 months and less than 12 months, after the basic medical insurance premium is paid back and the overdue fine is charged according to the regulations, it will be delayed for 6 months from the normal payment month to enjoy the medical insurance benefits, and the original payment period will continue to be calculated.

If the basic medical insurance premium is unpaid for more than 12 months, it will be regarded as automatic surrender, and if you participate in the basic medical insurance again, it will be treated as the initial insurance, and the previous payment period will be calculated discontinuously.

(3) The medical expenses incurred during the overdue period shall not be paid by the medical insurance pooling fund.

(XIII) How to handle the procedures for changing the basic data of the insured employees?

When the insured person goes through the formalities for changing the basic data such as ID number and name, he/she must carry the original and photocopy of the ID card or household registration book and other valid documents, and fill out the "Xuchang Social Insurance Basic Data Change Declaration Form". After being sealed by the unit, go through the formalities of change at the municipal medical insurance agency.

(14) How do the insured units go through the formalities for changing the registered items?

Where the name of the employing unit, the type of unit, the legal representative, the bank where the account is opened, the account number and other registered items are changed, and the employing unit is merged, divided, revoked or terminated according to law, it shall fill out the Xuchang City Social Insurance Basic Data Change Declaration Form, and go through the registration formalities for change with the application certificate and the approval of the relevant competent department.

(fifteen) how to handle the transfer procedures of the insured medical insurance relationship in the same city?

Insured personnel in the overall regional mobilization, by the redeployment of units for the specific procedures for the transfer of medical insurance relations, in accordance with the provisions, fill out the "Xuchang city social insurance overall regional change declaration form", redeployment and redeployment of units stamped with the official seal, in the month to the municipal medical insurance agencies for; If there is arrears, you must first make up the arrears before you can go through the transfer procedures.

(sixteen) how to handle the transfer and cancellation procedures of the medical insurance relationship of the insured?

If the insured person is transferred out of the overall planning area, he/she should carry his/her medical insurance IC card in the transfer unit, fill out the "Xuchang City Social Insurance Overall Planning Area Transaction Declaration Form", affix the official seal, and go through the transfer formalities with the municipal medical insurance agency.

When the insured terminates the medical insurance relationship due to death, going abroad and other reasons, the insured unit shall carry the death certificate, cremation certificate or other relevant materials, the original and photocopy of the medical insurance IC card, fill in the Application Form for Cancellation of Social Insurance for Employees, and affix the official seal of the unit. In the same month, I went to the municipal medical insurance agency to handle the cancellation procedures of the medical insurance relationship.

In the above two cases, after going through the relevant formalities, the personal account balance of basic medical insurance will be returned to me in one lump sum or legally inherited or transferred to the transfer place (the bank and account number of the medical insurance agency in the transfer place should be provided).

(seventeen) how to handle the medical insurance (renewal) procedures of the insured?

When handling the procedures for terminating insurance, the employing unit shall provide the documents for terminating or dissolving the labor relationship with the employees, and the employees who stop insurance shall sign the documents for dissolving the labor relationship; When going through the renewal procedures, you should pay the medical insurance premium owed during the period of suspension of insurance in accordance with the regulations, fill out the "Xuchang Social Insurance Suspension (Continued) Insurance Declaration Form", affix the official seal of the unit, and go to the municipal medical insurance agency for the same month.

(eighteen) how to handle the medical insurance for the retirement of the insured?

When the insured reaches the statutory retirement (post) age, they should fill in the Xuchang Social Insurance On-the-job Retirement Declaration Form in time, and the unit should affix its official seal, carry the retirement approval form and files approved by the human resources and social security departments, and go to the municipal medical insurance agency to handle the medical insurance on-the-job retirement procedures; If there is arrears, the medical insurance fee owed can be made up first before it can be processed.

(nineteen) how to reissue the lost medical insurance IC card?

The medical insurance IC card of the insured shall be properly kept. If you accidentally lose it, you should immediately hold the original and copy of your ID card or household registration book. If it is represented by others, it is also necessary to provide the original and photocopy of the agent's ID card, and go through the formalities of reporting the loss in the municipal medical insurance agency and reissue a new medical insurance IC card. The medical insurance IC card can't be used to report the loss.

(twenty) how to handle the medical insurance related procedures for the division, merger, cancellation, dissolution and bankruptcy of the employing unit?

When the employing unit is divided or merged, it must first pay off the social insurance premiums owed, and go through the relevant procedures of medical insurance with relevant documents and employee roster.

If the employer revokes, dissolves or goes bankrupt, it must first pay off the social insurance premiums owed, and the on-the-job workers will be transferred to the city employment service center, and the medical insurance relationship will be continued according to the basic medical insurance method for urban flexible employees; Retirees can enjoy medical insurance benefits for retirees after paying off the basic medical insurance and medical insurance premiums for serious illness relief for 10 years in one lump sum according to regulations.

(twenty-one) how can the unemployed who participate in the basic medical insurance in the employer continue the basic medical insurance relationship?

Unemployed people who have participated in the basic medical insurance in the employer should continue the medical insurance relationship within 3 months after the termination or dissolution of the labor relationship with the employer or after the end of the bankruptcy liquidation of the unit, such as the municipal employment service center. From the date of normal payment, you can enjoy the hospitalization expenses and treatment of serious chronic diseases paid by the basic medical insurance pooling fund according to regulations. The payment period is calculated continuously, and the balance of personal account funds continues to be used. After retirement is approved, when enjoying medical insurance benefits for retirees, it is not limited by the actual payment period 10 year. For those who have been dissatisfied with 12 months for more than 3 consecutive months, after paying the basic medical insurance premium in accordance with the regulations and adding a late fee, they will enjoy the medical insurance benefits for 6 months after the normal payment month, and the original payment period will continue to be calculated. Those who continue for more than 12 months shall be deemed as automatic surrender, and those who participate in the basic medical insurance again shall be treated as initial enrollment, and the previous payment period shall be calculated discontinuously.

(twenty-two) how to establish and use the basic medical insurance personal account?

Individual accounts consist of all medical insurance premiums paid by employees and part of medical insurance premiums paid by employers. Personal account of medical insurance is managed by medical insurance IC card. Monthly transfer of personal account funds: employees under 45 years old (including 45 years old) will be transferred according to 2.9% of the personal monthly payment base this year; On-the-job employees over the age of 46 are included in the monthly payment base of the individual this year (including the above-mentioned individual contributions). Retirees are included according to 3.4% of the average monthly retirement fee of the unit in the previous year.

(twenty-three) how to query the personal account balance of basic medical insurance?

At present, the personal account balance of the basic medical insurance for the insured in our city can be queried in the following ways:

1, you can swipe your card at designated medical institutions and pharmacies;

2, in the designated medical institutions or pharmacies with medical insurance IC card settlement costs, designated medical institutions or pharmacies to clearly show in the "medical insurance fee list":

3. In the city, the medical insurance agency can inquire by reading the card or entering the ID number and medical insurance IC card number;

4. Log in to the "Municipal Labor and Social Security Network" station of the Internet "Xuchang Information Port" and enter the ID number or medical insurance IC card number or social security number for inquiry;

5. The municipal medical insurance agency will issue the Personal Account Form of Medical Insurance to the insured through the employer every year;

(twenty-four) how to establish and use the basic medical insurance fund?

The basic medical insurance fund is composed of the basic medical insurance premium paid by the employer after deducting the part included in the personal medical account, and is managed and paid by the medical insurance agency in a unified way. The scope of the overall fund payment is the medical expenses for hospitalization and outpatient treatment of serious chronic diseases that meet the requirements of basic medical insurance.

(twenty-five) how to pay and use the medical insurance premium for serious illness relief?

At present, the insurance premium for serious illness relief is raised according to the standard of 90 yuan per person per year, which is borne by units or individuals, and can also be shared by units and individuals. The serious illness rescue insurance fund is raised by the medical insurance institution in a unified way and managed separately. If the medical expenses incurred by the insured in hospitalization and serious chronic outpatient service in the whole year (medical insurance year) exceed the medical expenses paid by the basic medical insurance pooling fund (excluding the part that individuals should bear in the total medical expenses when the accumulated expenditure of the basic medical insurance pooling fund reaches the top line) and meet the payment conditions of the pooling fund in the Interim Provisions on the Basic Medical Insurance for Urban Workers in Xuchang City, 90% of the medical expenses will be paid by the serious illness relief insurance fund, and the maximum medical expenses paid by the serious illness relief insurance fund per person per year will be 65,438.

(twenty-six) how to issue and use the national civil service Medicaid?

Medicaid for civil servants is paid monthly by the unit at the rate of 6% of the total wages. Mainly used to enjoy the personal accounts of Medicaid personnel and hospitalization medical expenses subsidies.

(1) Personal account subsidy: 2.8% of the wages paid by the employees, and 3.1%of the average retirement fee of the unit in the previous year;

(II) Subsidies used to enjoy the hospitalization medical expenses of Medicaid personnel (including the part paid by individuals for outpatient expenses of patients with severe chronic diseases included in the payment scope of the overall fund): individuals pay (except at their own expense) medical expenses above the Qifubiaozhun but below the maximum payment limit of the overall fund, with 50% of employees on the job and 60% of retirees;

(3) Medical expenses subsidy exceeding the maximum payment limit of basic medical insurance: 55% of the individual payment;

(4) Units participating in Medicaid for civil servants shall pay medical insurance premiums for serious illness relief for their employees every year, and the required expenses shall be charged from Medicaid for civil servants.

(5) medical expenses subsidies for medical personnel at public expense.

Third, medical care and reimbursement.

(27) How is the basic medical insurance coverage defined?

The scope of use of basic medical insurance is drugs listed in the list of drugs in basic medical insurance, and the insured uses drugs beyond this scope at their own expense. The drugs included in the basic medical insurance drug list are all clinically necessary, safe and effective, with reasonable price, convenient use and guaranteed market supply. The catalogue is divided into class A and class B. ..

1, "Class A List" drugs are necessary for clinical treatment, with wide application and good curative effect, and the price is lower among similar drugs. The expenses incurred in using Class A drugs shall be paid according to the provisions of basic medical insurance.

2. The drugs in the "Category B Drug List" are available for clinical use with good curative effect, and the price of similar drugs is slightly higher than that in the "Category A Drug List". The expenses incurred in using Class B drugs shall be paid by the insured according to a certain proportion, and then according to the provisions of basic medical insurance.

3, the cost of using Chinese herbal pieces, in addition to the basic medical insurance fund will not pay for drugs, are paid according to the provisions of the basic medical insurance.

The Category A Catalogue is formulated by the state and may not be adjusted in any place. The "Class B Catalogue" is formulated by the state, and the provinces can make appropriate adjustments according to the local economic level, medical needs and medication habits. Municipalities, prefectures, counties and districts have no right to adjust the Catalogue of Medicines for Basic Medical Insurance.

(28) What is the scope of basic medical insurance?

The basic medical insurance diagnosis and treatment project refers to all kinds of medical technical service projects and medical equipment, equipment and medical materials that meet the following conditions:

1, a necessary, safe, effective and affordable clinical diagnosis and treatment project;

2, by the price department to develop the diagnosis and treatment project fees;

3, designated medical institutions to provide designated medical services for the insured within the scope of diagnosis and treatment projects.

The basic medical insurance diagnosis and treatment items are divided into the diagnosis and treatment items that are not paid by the basic medical insurance, the diagnosis and treatment items that are paid by the basic medical insurance (also called special examination and treatment items) and the diagnosis and treatment items that are paid by the basic medical insurance.

The basic medical insurance does not pay for the diagnosis and treatment items, mainly those that are not necessary for clinical treatment and whose curative effect is uncertain, and those that belong to special medical services.

The basic medical insurance pays part of the cost of the diagnosis and treatment projects, mainly some necessary, effective but easy to abuse or expensive clinical diagnosis and treatment projects that need to be properly controlled.

Treatment items paid by basic medical insurance shall be paid according to the provisions of basic medical insurance.

The expenses incurred by using the basic medical insurance to pay for some medical treatment items (special inspection and special treatment items) shall be paid by the insured according to the prescribed proportion, and then paid according to the provisions of the basic medical insurance.

The cost of the medical treatment project that is not paid by the basic medical insurance shall be borne by the insured.

(twenty-nine) what expenses are not covered by the basic medical insurance reimbursement?

According to the relevant provisions of the basic medical insurance, all expenses incurred by the following diseases and behaviors are not included in the reimbursement scope of the basic medical insurance:

(1) Work-related injuries and occupational diseases; (2) Female workers give birth; (3) congenital diseases;

(4) accidental injury; (five) illegal crimes; (6) fighting;

(7) Suicide and self-mutilation; (8) drug addiction; (9) Traffic accidents;

(10) medical accident; (1 1) Quit smoking and drinking; (12) standard

(13) Other expenses not belonging to the basic medical insurance fund.

(30) How to seek medical treatment and medication in the outpatient department of the insured?

(1) The insured person goes to the outpatient department of the designated medical institution with his medical insurance IC card.

(2) The insured person must adhere to the principle of treating patients due to illness and rational drug use, and must not "hitchhike, prescribe large prescriptions, and be considerate"; A prescription should be controlled according to the dosage of acute oral drugs for 3 days, chronic drugs for 7 days, no more than 5 doses of Chinese herbal medicines and intravenous infusion for no more than 3 days.

(3) When the outpatient medical expenses incurred by the insured in the designated medical institutions are enough to pay, the expenses that meet the medical insurance regulations shall be settled directly with the medical insurance IC card in the hospital medical insurance charging window, and some of them shall be paid in cash at their own expense; When the personal account balance is insufficient to pay, pay cash settlement.

(4) When the insured person settles the medical expenses in the medical personal account, the designated medical institution will print the detailed list of expenses and pay it to the insured person.

(5) Designated medical institutions shall not provide non-pharmaceutical commodities, drugs and medical treatment items to the insured.

(thirty-one) how to buy drugs from designated retail pharmacies?

(1) The insured person buys medicines within the scope of medical insurance at designated retail pharmacies, and can directly swipe the medical insurance IC card for settlement when the personal account has money. When the money in his personal account is not enough to pay for medicine, the balance should be paid in cash.

(2) When purchasing over-the-counter drugs within the scope of medical insurance, the insured person can directly swipe the medical insurance IC card without holding a prescription issued by a doctor in a designated medical institution; When the insured person purchases prescription drugs in medical insurance coverage, he must purchase them according to the regulations with the prescriptions issued by doctors in designated medical institutions.

(3) The drug purchase quantity is generally controlled to be no more than 3 days for acute oral drugs and no more than 7 days for chronic diseases; Take no more than 5 doses of Chinese medicine each time, and drip it intravenously for no more than 3 days each time.

(4) After the insured uses the medical insurance IC card to purchase medicine, the designated retail pharmacy prints the expense list for the insured.

(five) drugs and commodities that do not belong to medical insurance coverage shall not be paid with funds from personal accounts of medical insurance.

(32) How to seek medical treatment in outpatient department for severe chronic diseases? How to reimburse the expenses?

When seeking medical treatment in the outpatient department of severe and chronic diseases, you should hold the Medical Card for Severe and Chronic Diseases to the designated medical institutions for medical treatment. Doctors must first verify the identity of patients according to regulations. After the witness is consistent, the drug should be used according to the diseases shown in the medical card for severe chronic diseases. The doctor should write down the disease type, condition, card number, unit, etc. In the prescription, you are also not allowed to exchange and prescribe drugs needed for other diseases. The oral dosage of a prescription shall not exceed 10 days. If the prescription amount exceeds 100 yuan, it must be approved by the designated hospital medical insurance office. More than 200 yuan, must be audited by the designated hospital medical insurance office, reported to the medical insurance agency for approval. Outpatient fees are paid by individuals. The medical expenses for severe chronic diseases in the first month of each quarter are 1.