The three main catalogs of medical insurance (drug catalog, diagnostic and treatment items, and scope of medical service facilities), including the drug catalog of western medicine and pCms, are differentiated as "Class A drugs and Class B drugs". Diagnostic and treatment programs are also divided into "Class A and Class B" (each city may be called differently), Class A drugs and diagnostic and treatment programs do not need to bear a certain percentage of their own.
But in most areas, there is a starting line, a ceiling, and a percentage of benefits.
Category A refers to the state regulations, clinical treatment needs of category A drugs. Widely used in the same class of drugs, therapeutic efficacy, low price, the costs incurred in the use of these drugs should be included in the scope of contributions to the basic medical insurance fund and paid in accordance with the provisions of the basic medical insurance scheme, 100 percent of the Class A drugs are reimbursed according to the reimbursement ratio.
Medicare reimbursement is Category A can be reported or Category B?
When it comes to health insurance reimbursement, both Class A and Class B drugs are covered by the health insurance reimbursement catalog, but the reimbursement rates for Class A and Class B are different.
The reimbursement rates for Class A drugs are often higher than those for Class B drugs. Generally speaking, Class A drugs are essential for clinical treatment, widely used and effective drugs, which are fully included in the scope of reimbursement of medical insurance, which means that the reimbursement of Class A drugs is fully reimbursed; Class B drugs are reimbursed in accordance with a certain percentage, and need to bear part of the cost, which is an optional use of Class B drugs, which are effective and expensive, which is also higher than the Class A drugs. Class B drugs are optional, effective, and more expensive than Class A drugs. The reimbursement rate for Class B is generally between 70% and 80%, and may vary by region and type of health insurance.
It is worth mentioning that the reimbursement of health insurance is essentially a reimbursement of the money from the health insurance fund account, not the money from the individual account of the health insurance. Often, if you are in a designated hospital for medical treatment, you can do this directly through the hospital's health insurance settlement window when you are discharged.
Legal basis:
Interim Measures for the Administration of Basic Medical Insurance
Article 25: The use of Class A drugs by insured persons shall be paid for in accordance with the payment standards and sharing methods stipulated by the basic medical insurance; the use of Class B drugs shall be paid for in accordance with the payment standards and sharing methods stipulated by the basic medical insurance; the use of Class B drugs shall be paid for in accordance with the payment standards and sharing methods stipulated by the basic medical insurance. The use of "Class A drugs" by the insured shall be paid in accordance with the payment standards stipulated by the basic medical insurance, and a certain proportion of the payment shall be paid by the insured out-of-pocket first, and then in accordance with the sharing methods stipulated by the basic medical insurance. The proportion of out-of-pocket payment for "Class B drugs" is determined by the provincial or regional medical insurance administrative departments.