The National Medicines Catalogue of Basic Medical Insurance divides medicines into three categories: Class A, which can be reimbursed in full, according to the proportion of the medical insurance; Class B, which requires individuals to bear part of the cost in a certain proportion, and then the rest of the cost will be reimbursed in full, according to the proportion of the medical insurance; Class C, which is not reimbursed; and Class D, which is not reimbursed at all, but is reimbursed by the government, and is not reimbursed by the government. According to the proportion of medical insurance reimbursement; the third category C, this part of the drug is not reimbursed, all borne by the individual. Therefore, in addition to the items that must be deducted for Category A drugs, the other 100% reimbursement; Category B drugs are only part of the reimbursement of 70%-80%, and self-financed drugs need to be borne by themselves. That is to say, 15% of the total cost is not related to the medical insurance cost, which is the so-called category C cost is paid in cash. The reimbursement amount = (total cost - starting line - self-payment for category B - full self-payment) x reimbursement rate.
What are the items included in the reimbursement of medical insurance
The classification of medical insurance reimbursement and the items included are as follows:
1, general medical insurance. It mainly includes outpatient expenses, medical expenses, examination expenses, and so on.
2, hospitalization insurance. It mainly covers daily hospitalization fee, cost of utilizing hospital equipment, surgery cost, medicine cost, etc.
3. Surgical insurance. Provides for all expenses incurred due to necessary surgery required by the patient.
4. Comprehensive medical insurance. Its cost coverage includes all costs of medical treatment and hospitalization and surgery, etc.
5, special disease insurance. Certain special diseases often bring the patient a catastrophic cost payment, the average resident family can hardly afford. Examples include cancer and heart disease. Provide coverage for policyholders of major diseases, can be a single, such as malignant tumors, or even malignant tumors in a certain number of cancers.
I hope the above can help you, if you have other questions please consult a professional lawyer.
Legal basis:
Article 30 of the Social Insurance Law of the People's Republic of China*** and the State of China, the following medical expenses are not included in the scope of payment of the basic medical insurance fund:
(a) should be paid from the workers' compensation insurance fund;
(b) should be borne by a third party;
(c) should be borne by the public ****health;
(d) ) for medical treatment outside the country.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party 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.