Generally Class A drugs are reimbursed at 100% except for items that must be deducted, Class B drugs are reimbursed only partially at 70%-80%, and self-pay drugs require you to bear the entire cost.
Reimbursement amount = (total cost - the starting line - Class B out-of-pocket - full out-of-pocket) × reimbursement rate, 100% reimbursement for Class A drugs, then it is that the cost of the drug is fully reimbursed, their own pennies do not have to pay. Class B drugs 70% of the standard, then that is to say 100 yuan of money for the cost of drugs you only need to pay 30 yuan, the remaining 70 yuan is the reimbursement of the cost of the automatic reimbursement in the hospital checkout discharge time.
The drugs of "Class A drugs" are those that are basically uniform across the country and can guarantee the basic needs of clinical treatment. The cost of such drugs is included in the scope of payment of the basic medical insurance fund, and the cost is paid according to the payment standard of the basic medical insurance.
The drugs in "Class B drugs" refer to those drugs for which the basic medical insurance fund has the ability to partially cover the costs, and are appropriately adjusted by provinces, autonomous regions and municipalities directly under the central government according to the economic level and drug habits, etc. The proportion of the medical insurance fund to be paid is determined by the coordinating regions in accordance with the affordability of the local medical insurance fund, i.e., this kind of drugs is firstly paid for by the employees at their own expense by a certain proportion, and then included in the basic medical insurance fund. In other words, these drugs are first paid for by the employees at a certain percentage of their own expense, and then they are included in the scope of payment by the basic medical insurance fund, and the expenses are paid according to the standard of payment by the basic medical insurance.
Expanded information:
The main categories of costs that Medicare will not pay for include the following:
1. Services.
(1) Registration fee, medical record cost.
(2) Consultation fee, consultation fee (including home bed rounds fee), examination and treatment expediting fee, surcharge for named surgery, quality premium fee, escort fee, self-invited special nurse fee and other special service fees.
2. Non-disease treatment program category.
(1) Various beauty and fitness programs and some non-functional cosmetic and orthopedic surgery costs.
(2) a variety of weight loss, fat gain, height increase program.
(3) Various health checkups.
(4) Various preventive and health care treatment programs.
(5) A variety of medical consultation, medical appraisal program.
3, medical materials.
(1) eyeglasses, dentures, eye prostheses, prosthetic limbs, hearing aids and other rehabilitative devices.
(2) a variety of self-use health care, massage, examination and treatment equipment.
(3) Buried automatic defibrillator (ICD).
(4) Provincial and municipal price department regulations can not be charged separately for disposable medical materials.
4, diagnostic and treatment equipment category.
Application of positron emission tomography device (PET), electron beam CT, ophthalmic excimer laser treatment device and other large medical equipment for examination and treatment programs.
5, treatment program category.
(1) all kinds of organ or tissue transplantation of organ source or tissue source.
(2) Organ transplants or tissue transplants other than kidney, heart valve, cornea, skin, blood vessel, bone, and bone marrow transplants.
(3) Orthopedic surgery for myopia.
(4) Complementary therapeutic programs such as qigong therapy, music therapy (except for psychiatric patients), health care nutritional therapy, and magnetic therapy.
6. Others.
(1) a variety of infertility (fertility), sexual dysfunction diagnosis and treatment programs.
(2) a variety of scientific research, clinical verification of the treatment program.
(3) All expenses incurred due to fighting, assault, alcoholism, traffic accidents, medical accidents, injury liability accidents, and intentional self-injury and self-mutilation.
(4) Medical expenses incurred during the period of going abroad and traveling to Hong Kong, Macao and Taiwan for family visits, meetings, study tours, further training and lectures.
(5) Except for emergency and first-aid, medical treatments conducted by the designated medical institutions that are beyond the scope of the registered treatment subjects.
(6) Diagnostic and therapeutic programs conducted by the designated medical institutions in cooperation with foreign countries.
(7) Diagnostic and therapeutic items that are not included in the medical service charge standards stipulated by the provincial and municipal price departments.
References:
Expanded reading: insurance how to buy, which is good, hand to hand to teach you to avoid the insurance of these "pits"