In short, regardless of class A, class B and class C; Whether outpatient or inpatient, most hospitals will indicate the "self-care ratio" of each drug, medical materials, inspection, laboratory tests and other expenses in their invoices or hospitalization fees; If not specified, the hospital may be a "non-medical insurance designated hospital".
1, different classification methods:
"Class A drugs" are necessary for clinical treatment, with wide application, good curative effect and low price among similar drugs.
"Class B drugs" are available for clinical use with good curative effect, and the price of similar drugs is slightly higher than that of "Class A drugs list".
"Class C drugs" refer to drugs that are unnecessary and expensive in clinic except the above two categories. Class C drugs generally include: health care products, high-grade drugs, newly developed drugs, imported anticancer drugs, etc.
2. The formula method is different:
"Class A drugs" are uniformly formulated by the state and may not be adjusted in various places.
"Class B drugs" are formulated by the state and all provinces, autonomous regions and municipalities directly under the Central Government.
People who don't belong to categories A and B belong to category C. ..
3. There are differences in reimbursement rates.
When the insured uses "Class A drugs", they can all be included in the scope of reimbursement, and the basic medical insurance fund will be reimbursed according to the prescribed proportion.
When the insured person uses "Class B drugs", he must first deduct a certain amount of personal out-of-pocket expenses according to the proportion (local regulations), and then include the remaining expenses in the scope of reimbursement and reimburse them according to the prescribed proportion.
When the insured uses "Class C drugs", the basic medical care is not covered, and most areas need to pay by themselves 100%.
legal ground
Notice of the Ministry of Labor and Social Security, the State Development Planning Commission and the State Economic and Trade Commission on Issuing the Interim Measures for the Administration of the Scope of Medication of Basic Medical Insurance for Urban Employees.
Article 6 The western medicines and Chinese patent medicines in the Drug Catalogue are selected on the basis of national essential medicines, and are divided into "Class A Catalogue" and "Class B Catalogue". The drugs in Class A Catalogue are necessary for clinical treatment, widely used, with good curative effect and low price among similar drugs. The drugs in the "Category B Drug List" are available for clinical use with good curative effect, and the price of similar drugs is slightly higher than that in the "Category A Drug List".
Article 7 The Catalogue of Class A shall be formulated by the state and may not be adjusted in any place. The "Category B Catalogue" is formulated by the state, and all provinces, autonomous regions and municipalities directly under the Central Government may make appropriate adjustments according to the local economic level, medical needs and drug use habits. The sum of the number of varieties increased or decreased shall not exceed 15% of the total number of drugs in the Class B Catalogue formulated by the state.
Provinces, autonomous regions and municipalities directly under the central government may, according to clinical indications and hospital levels, restrict drugs that are easy to be abused and have great toxic and side effects in the drug list and Class B list of the province (autonomous region or municipality directly under the central government).
Eighth basic medical insurance insured to use the "Drug List" drugs, the expenses incurred by the payment according to the following principles.
The expenses incurred in using Class A drugs shall be paid in accordance with the provisions of the basic medical insurance. The expenses incurred in the use of "Category B drugs" shall be paid by the insured according to a certain proportion, and then according to the provisions of the basic medical insurance. The specific proportion of individual pays shall be stipulated by the overall planning area and reported to the administrative departments of labor security of provinces, autonomous regions and municipalities directly under the Central Government for the record.
The expenses incurred in the use of Chinese herbal pieces shall be paid in accordance with the provisions of the basic medical insurance, except for drugs that are not paid by the basic medical insurance fund.