Basic medical insurance "three catalogs" refers to the basic medical insurance drugs, diagnostic and therapeutic items, service facilities standard catalog.
Because the health insurance fund is limited, it is impossible to cover all the medical needs, so in order to protect the basic medical needs of the insured, reasonably control the medical expenses, standardize the management of the basic medical insurance drugs, diagnosis and treatment, and to ensure the healthy operation of the basic medical insurance system, the medical insurance department stipulates the basic medical insurance for the drugs, diagnostic and therapeutic items, and the scope of reimbursement of medical service facilities, which is commonly known as the "three catalogs". The medical insurance department stipulates the scope of reimbursement for medicines, diagnostic and treatment items and medical service facilities of basic medical insurance, which is commonly known as the "three catalogs".
Reimbursement Scope and Ratio
The medicines in the medical insurance drug catalog are divided into "Class A" and "Class B", and the reimbursement rates for medicines in these two classifications are different when calculating reimbursement amounts.
Category A drugs in the medical insurance drug list are those that are necessary for clinical treatment, widely used, have good therapeutic effects, and are low-priced among similar drugs. When using these drugs, participants can be fully covered by the reimbursement scope and reimbursed at the prescribed rate.
Category B drugs are drugs that can be used for clinical treatment, have good therapeutic effects, and are more expensive than Category A drugs in the same category. When a participant uses a Class B drug, a certain amount of personal out-of-pocket expenses will be deducted according to the proportion, and then the remaining expenses will be included in the scope of reimbursement and reimbursed according to the prescribed proportion.
The above content refers to Jiayuguan Medical Security Bureau - What are the "three catalogs" of medical insurance?