Rules for the implementation of the policy on medical services for assisted reproduction

Recently, the Weifang Municipal Medical Security Bureau issued the "Notice on printing and distributing the Price and medical insurance payment Policy of some medical service items", and since April 1, assisted reproductive medical service items will be included in the scope of medical insurance payment.

According to the notice, medical institutions providing assisted reproductive medical services will adopt the separate pricing method of "service items + special consumables", and in accordance with the basic principle of "output orientation", the establishment, revision and suspension of some medical service price items will be priced in the form of government-guided prices. The specific implementation standards of fees are: 100% of the price of Annex 1 for tertiary medical institutions, 90% of the price of Annex 2 for secondary medical institutions, and 80% of the price of Annex 2 for primary and lower medical institutions. In order to facilitate the implementation of medical institutions, the price will be retained to yuan, rounded below yuan.

Regarding the medical insurance payment policy, the notice clarifies the medical service items covered by the basic medical insurance fund and the individual out-of-pocket payment ratio, which is 15% and 20% respectively for employees' medical insurance and residents' medical insurance. The cost of therapeutic assisted reproduction is limited to outpatient payment, the proportion of employee medical insurance payment is 80%, and the annual payment limit is 15,000 yuan; The payment ratio of low-grade and high-grade contributions for residents' medical insurance is 55% and 65%, respectively, and the annual payment limit is 5,000 yuan. Without the approval of the health department to carry out human assisted reproductive technology designated medical institutions, the medical insurance fund related to assisted reproductive expenses shall not be paid.

The notice requires that all relevant medical institutions should do a good job of price publicity in a prominent place in the charging place and accept social supervision. Medical insurance administrative departments, handling agencies and auditing institutions at all levels should do a good job in accordance with their duties.

This policy will be officially implemented from April 1, 2024.