Example: An employee in a coordinated area incurred hospitalization medical expenses of 20,000 yuan, of which 7,000 yuan were spent on medicines, respectively 5,000 yuan on Class A medicines, 1,000 yuan on Class B medicines, and 1,000 yuan on medicines not included in the Medicines Catalogue. Then the payment method for the employee's hospitalized medical expenses is as follows:
(1) $1,000 of the cost of drugs not in the Drug Catalog shall be paid by the employee in full;
(2) $1,000 of the cost of Class B drugs shall be paid by the employee firstly at 20% of the out-of-pocket payment, i.e., $200;
(3) $5,000 of the cost of Class A drugs and 80% of the cost of Class B drugs (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.
When used on an outpatient basis, they can all be paid from the individual medical insurance account on the card.
Hospitalization use, Class B drugs and other Class B costs, the participant settlement, Class B first out-of-pocket payment of 10%, and Class A costs together with the basic medical expenses, more than the hospital threshold fee for the part of the overall payment rate together (urban workers' health insurance 80 percent, urban residents' health insurance 40 percent).
Simply put, Category B costs are more out of pocket when you are hospitalized. Medical insurance hospitalization reimbursement - out-of-pocket expenses in addition to the first 10 percent of Category B costs out-of-pocket, more than the threshold of the part of the fee, can be "reimbursed" more than 80 percent (occupational insurance). Instead of reimbursing you with bills after you advance cash, when you are hospitalized in a designated medical insurance hospital, you will present your medical insurance card to the unified medical insurance settlement system to read the information of the insured person and apply for a hospitalization number, and then when you are discharged from the hospital, the medical insurance system will not charge you the "reimbursable" portion of the reimbursement --- the integrated payment portion.
Basic medicines are included in the Medicare Class A catalog
The Ministry of Human Resources and Social Security formally released the 2009 version of the National Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance Drug Catalog on November 30, 2009, which includes all therapeutic medicines in the National Basic Medicines Catalog in the Class A portion of the Drug Catalog.
The National Drug List for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance is an important standard for the management of basic medical care, work injury and maternity insurance, and the former Ministry of Labor and Social Security issued two editions of the Drug List in 2000 and 2004, which have been widely implemented across the country to guarantee the basic medication needs of insured persons.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China is in line with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as emergency and rescue medical expenses, which shall be paid from the basic medical insurance fund in accordance with state regulations.