How to reimburse the medical insurance A, B, C, three categories of drugs

The first category A, can all enter the scope of health insurance reimbursement, according to the local health insurance ratio reimbursement (100%); the second category B, with this kind of drugs need to be part of the cost of the individual first according to a certain percentage of the remaining part of the scope of health insurance reimbursement, reimbursement according to the proportion of the health insurance; the reimbursement of social security ratio of the second category of drugs is: the individual to pay the first 10 percent of the drug after the first reimbursement of the same proportion as the category A. The third category C, this part of the drug is not reimbursed, all by the individual. 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 should set up a settlement system for medical expenses incurred in other places to facilitate the enjoyment of basic medical insurance by the insured.

Medicare medicines are divided into three major categories: A, B and C. All medicines in category A can be entered into the medical insurance program. Class A medicines can be fully covered by medical insurance and reimbursed at the local medical insurance rate (100%); Class B medicines require individuals to pay 10% of the amount upfront, and then the remaining 90% of the amount can be outpatient 45% co-ordination and 90% co-ordination of chronic diseases; Class C medicines are 100% out-of-pocket and cannot be co-ordinated.

How to categorize the medicines in Category A, B and C of the medical insurance

1, Category A medicines

The medicines which are necessary for clinical treatment, widely used, with good therapeutic effect, and with a low price in the same kind of medicines. When the insured person uses this kind of drugs, the full amount can be included in the scope of reimbursement, and reimbursement will be made in accordance with the prescribed ratio;

2. Class B drugs

can be used as a choice for clinical treatment, with good therapeutic effect, and the price of the drugs in the same class is higher than that of the Class A drugs. When a participant uses a Class B drug, a certain amount of personal out-of-pocket expenses will be deducted according to the proportion (set by each region), and then the remaining expenses will be included in the reimbursement scope and reimbursed according to the stipulated proportion;

3. Class C drugs

Basic medical care is not covered, and in most of the regions, individuals are required to pay 100% out-of-pocket expenses. Of course, some areas may also be reimbursed some of the specific can look at the hospital invoice on the "self-care ratio" column. The C drugs generally include: health care products, high-grade drugs, newly developed drugs, anti-cancer imported drugs and so on.

All in all, regardless of Class A, Class B, Class C, or outpatient, inpatient, most of the hospital invoices or hospitalization fee details will be on each drug, medical materials, inspection, laboratory tests and other costs of the "self-care ratio" to mark. If not, the hospital may be a "non-medical insurance designated hospital".

Legal basis:

Interim Measures for the Administration of the Scope of Medicines Used by Urban Workers in Basic Medical Insurance

Article 8

The expenses incurred by basic medical insurance participants for the use of medicines in the Medicines Catalog shall be paid on the basis of the principle of the following. Expenses incurred for the use of drugs in the "Class A List" shall be paid in accordance with the provisions of the basic medical insurance. Expenses incurred for the use of drugs in the "Class B List" will be paid by the insured person at a certain percentage of his/her own expense, and then paid in accordance with the provisions of the basic medical insurance. The specific proportion of out-of-pocket payment by individuals shall be stipulated by the coordinating area and reported to the labor security administrative department of the province, autonomous region or municipality directly under the central government for the record. The costs incurred in the use of traditional Chinese medicine tablets, in addition to the basic medical insurance fund does not pay for drugs, are paid in accordance with the provisions of the basic medical insurance.