Category B drugs are only partially reimbursed at a rate of 70% to 80%, while self-paid drugs are fully covered by the individual. Class B list is set by the state, each province, autonomous region, municipality directly under the Central Government can be based on the local economic level, medical needs and medication habits, appropriate adjustments are written into the individual provinces and municipalities of the medical insurance drug list, the number of varieties of increase and decrease in the number of varieties of drugs does not exceed the number of nationally formulated Class B list of drugs by 15 percent.
The health insurance department stipulates the scope of reimbursement of basic medical insurance for drugs, diagnostic and treatment items and medical service facilities, commonly known as the "three catalogs". To put it simply, if a participant's expenses for drugs, diagnostic and therapeutic items or medical service facilities fall within the "three catalogs", he or she can be reimbursed in accordance with the regulations; if they don't fall within the "three catalogs", they will not be reimbursed by the health insurance.
The basic medical insurance drug list, one of the three catalogs, consists of two parts: the Class A drug list and the Class B drug list.
Medicare reimbursementThe scope of reimbursement for urban medical insurance refers to all employers in towns and cities, as follows:
1. including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.);
2. organs, institutions, public organizations, social groups, private non-enterprise units and their employees, are required to participate in the basic medical insurance;
3. ...Some cities and towns have stipulated that township and village enterprises and their employees, as well as owners of urban individual economic organizations and their employees, should gradually be included in the scope of basic medical insurance (the last of which varies according to the policies of each locality), so that they can enjoy medical reimbursement.
The urban medical reimbursement mainly refers to is in the hospital to see a doctor, medicine, hospitalization, surgery, etc., can be through the medical insurance card in accordance with the relevant provisions of the medical cost reimbursement, urban medical insurance is more specialized, the project size and coverage is larger, but its in the major illnesses or accidents in the payment is limited, the author suggests that the participants can be separately purchased commercial catastrophic medical supplement insurance and social security to reduce their financial losses.
Legal basis:
The People's Republic of China Social Insurance Law
Article 28 of the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance fund.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Article 30 The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the workers' compensation insurance fund;
(2) those that should be borne by a third person;
(3) those that should be borne by the public ****health;
(4) those that seek medical treatment outside China.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.