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Clear! These items can be included in Medicare reimbursement

From 1 October 2024

Foshan will "egg retrieval" and so on

8 assisted reproductive medical service projects

Included in the scope of medical insurance payment

What are the specific reimbursable assisted reproduction diagnosis and treatment items?

At which designated medical institutions are eligible for reimbursement?

How much does it cost?

That's all you need to ask!

Clear! These items can be included in Medicare reimbursement

Q1

What are the designated medical institutions in Foshan that can enjoy reimbursement for assisted reproduction?

According to the "List of Institutions Approved to Carry Out Assisted Reproductive Technology and Set Up Sperm Banks in Guangdong Province", there are 4 designated medical institutions in our city that have been approved to carry out human assisted reproductive technology services, all of which are tertiary hospitals, namely: Foshan First People's Hospital, Foshan Maternal and Child Health Hospital, Shunde Hospital of Southern Medical University, and Shunde Women and Children's Hospital of Guangdong Medical University.

Q2

What are the assisted reproductive diagnosis and treatment items that can be reimbursed? What is the government-guided price of the project?

According to the relevant regulations of our city, the price items of 8 assisted reproductive medical services such as "egg retrieval", "embryo culture", "embryo transfer", "tissue and cell biopsy (assisted reproduction)", "artificial insemination", "sperm optimization treatment", "sperm retrieval" and "sperm injection" are included in the scope of basic medical insurance payment, as shown in the following table.

Clear! These items can be included in Medicare reimbursement

Q3

How much does an assisted reproduction program cost? What is the difference between before and after?

The Provincial Medical Insurance Bureau optimizes and integrates the current price items of assisted reproductive medical services in our province into 12 projects, and public medical institutions to carry out assisted reproductive medical services are charged according to these 12 items, and other medical service price items are not allowed to be charged, which standardizes the charging behavior of medical institutions to carry out assisted reproductive medical services.

Based on the results of the cost survey, our bureau comprehensively considers the city's economic and social development level, medical service capacity of medical institutions, medical service needs of the masses, medical insurance fund affordability and other factors to formulate government guidance prices for 12 projects and implement provincial benchmark prices. Public medical institutions shall charge fees in accordance with the government's guidance price, and the price shall not be increased during implementation, and there is no limit to the reduction.

Compared with the current situation, the price of the project has risen and fallen, and the total medical cost of the 12 assisted reproductive medical service projects after pricing has decreased by about 1,725 yuan, a decrease of about 9%.

Q4

What are the medical insurance benefits for infertility treatment in outpatient surgery?

The city's documents require that the assisted reproductive diagnosis and treatment projects be included in the city's second-class outpatient specific disease management, and the name of the disease is "infertility outpatient assisted reproductive technology", and the validity period of the disease is 1 year.

Q5

What is the reimbursement ratio for outpatient specific diseases "infertility outpatient assisted reproductive technology"?

Before the implementation of the new policy, infertility outpatient assisted reproductive technology projects were all self-funded. At present, the proportion of outpatient medical expenses for infertility assisted reproductive technology treatment within the scope of the policy shall be implemented with reference to the hospitalization standard. According to the regulations, the current medical institutions that provide assisted reproductive technology treatment in our city are all tertiary hospitals, and the proportion of medical insurance payment for employees is 87%, and the proportion of medical insurance payment for residents is 85%.

Q6

What is the maximum payment limit for the specific type of outpatient "infertility outpatient assisted reproductive technology" within the validity period?

The maximum payment limit for employee medical insurance is 20,000 yuan, and the maximum payment limit for resident medical insurance is 16,000 yuan during the validity period of resident medical insurance.

Q7

Can other medical expenses such as consumables, medicines, and medical services incurred during assisted reproductive technology treatment be reimbursed?

Yes, according to the provisions of the city's documents, the outpatient medical expenses for infertility assisted reproductive technology treatment belong to the reference door guarantee of assisted reproductive technology, and other items are implemented according to the provisions of basic medical insurance.

Eight assisted reproductive treatment items such as "egg retrieval" will be added to the scope of basic medical insurance payment. For the insured to carry out infertility assisted reproductive technology treatment in the outpatient clinic, with reference to the management of specific diseases in the second-class outpatient clinic, the medical expenses incurred in the tertiary medical institutions that are included in the scope of medical insurance payment shall be reimbursed by residents and employees for 85% and 87% respectively. Among them, the maximum payment limit of employee medical insurance is 20,000 yuan, and the maximum payment limit of resident medical insurance is 16,000 yuan.

The implementation of this policy will effectively alleviate the financial burden of families such as fertility difficulties and help them realize their "childbearing dreams" as soon as possible

Clear! These items can be included in Medicare reimbursement
Clear! These items can be included in Medicare reimbursement
Clear! These items can be included in Medicare reimbursement

Foshan Publishing Editorial Department

Source: Foshan Medical Security Bureau

Editor: Mei Yushan Reviewer: Mai Limin, Liu Yanjun