The reimbursement rate for Class A drugs is 100 percent, while that for Class B drugs is 70-80 percent. The National Medicines List of Basic Medical Insurance divides medicines into three categories: Category A can be reimbursed in full according to the proportion of medical insurance; Category B requires individuals to bear part of the cost first according to a certain proportion, and then the rest of it will be reimbursed according to the proportion of medical insurance stipulated by the law; and Category C is not reimbursed, and is borne entirely by the individual.
Example: a coordinated area of a worker incurred hospitalization medical expenses of 20,000 yuan, of which 7,000 yuan of drug costs, respectively, 5,000 yuan of Class A drugs, Class B drugs 1,000 yuan, not the "Drug Catalog" of the drug costs of 1,000 yuan. Then the payment method for the employee's hospitalized medical expenses is as follows:
(1) 1,000 yuan of the cost of drugs not in the "Drug Catalog" shall be fully paid by the employee;
(2) 1,000 yuan of the cost of drugs of Class B shall be paid by the employee firstly by paying 20% out of his own pocket, i.e., 200 yuan;
(3) 5,000 yuan of the cost of drugs of Class A and 80% of the cost of drugs of Class B (i.e. 800 yuan),*** 5,800 yuan together with other medical expenses that should be included in the scope of payment of the coordinated fund shall be paid in accordance with the provisions on reimbursement of hospitalization expenses under the basic medical insurance.
Legal basis
The People's Republic of China*** and the State Social Insurance Law
Article 28 of the Law stipulates that medical expenses in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards as well as those for emergency treatment and salvage shall be paid out of the basic medical insurance fund in accordance with the state regulations.
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 social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the enjoyment of basic medical insurance by insured persons.