The difference between Class A and Class B of the National Health Insurance;
"Class A" medicines are essential for clinical treatment, widely used, efficacious, and less expensive in the same class of drugs; they are formulated by the state, and may not be adjusted in any part of the country, and the costs incurred by the use of "Class A medicines" are not covered by the National Health Insurance. The costs incurred in the use of "Class A drugs" are paid in accordance with the provisions of the basic medical insurance. Class "B" drugs are drugs that can be chosen for use in clinical treatment, have good therapeutic effects, and are slightly more expensive than Class "A" drugs in the same category; Class "B" drugs are formulated by the State, and are subject to adjustment by the provinces, cities and districts in accordance with local economic levels, medical needs and the needs of the local community. According to the local economic level, medical needs and habits of medication appropriate adjustments, but can not exceed the national development of "Class B drugs", the total number of 15% of the cost of health insurance is not related to the so-called Class C costs are all paid by cash.
Category A drugs refer to the nationally developed, clinically necessary, widely used, efficacious, and low-priced drugs of the same type, and the costs incurred by the use of such drugs are included in the scope of the basic medical insurance fund, and the costs are paid in accordance with the provisions of the basic medical insurance scheme. Class B drugs are those drugs for which the basic medical insurance fund has the ability to partially cover the costs, and the costs incurred in the use of such drugs are first paid for by the employee as a certain percentage of the costs before being included in the scope of benefits of the basic medical insurance fund, and the costs are paid in accordance with the provisions of the basic medical insurance scheme.
The difference between Category A and Category B costs is that individuals bear a different proportion. Patients in category A bear only one out-of-pocket percentage, while those in category B have to bear the percentage twice, i.e., they bear one out-of-pocket percentage first, and then the remaining portion of category B bears the same out-of-pocket percentage as that for category A. Medicare hospitalization and Medicare-related expenses are subject to a starting line, and only the portion above the starting line can be reimbursed according to the A and B percentages. The starting line is calculated only for Category A and B costs, not for non-Medicare-related Category C costs.
Medicare reimbursement = total hospitalization cost (i.e., non-Medicare-related C costs + the sum of Medi-Cal-related A and B costs) - non-Medicare-related C costs - the starting line - the out-of-pocket portion of the A - the portion of the B that will be borne by the ratio of the two. .
Category A drugs are reimbursed 100% at the reimbursement rate. Category B has to pay part out-of-pocket and be reimbursed part out-of-pocket, and the exact reimbursement rate varies according to local policies and specific drugs. It is important to note that the portion that goes into the basic medical fee is only reimbursed according to the prescribed rate and standard after it is higher than the starting standard of the basic medical fee.
The medical insurance catalog is based on the national essential drugs catalog screening, A and B categories are determined according to the efficacy of the price ratio, that is to say, the efficacy of the exact and low cost are included in the A category, do not need to pay. And the B class basically has a self-payment ratio, the same kind of medicine in different provinces and cities, the self-payment ratio is different. Specifically set by the local; there are local labor and social security bureau of health insurance category B varieties have the right to adjust the total amount of transfer in and out of the variety of control within 15% of the number of varieties, while the local have no right to health insurance category A varieties to do adjustments. The significance of the medical insurance catalog for sales is through the hospital promotional model down to marketing. Many patients seek medical treatment is to have medical insurance, but not. The varieties on the medical insurance catalog are not in the reimbursement scope, and need to be solved at their own expense. So not into the health insurance catalog varieties in the hospital sales will be limited by the volume, and in the insurance catalog scope of nature can break through the patient's psychological bottleneck. Moreover, many hospitals are also publicly-funded hospitals, and there are regulations regarding the importation of medicines. Whether it is an insurance catalog is very important.