Medical insurance catalog Category A Category B
In the three major catalogs of medical insurance, the catalogs of medicines and treatment items are divided into "Category A" and "Category B". The scope of reimbursement for medicines and diagnostic and therapeutic programs corresponding to "Class A" and "Class B" are different. No.1 What is the meaning of "Class A" and "Class B" in the Medicare Drug List? The medicines in the Medicare Drug List are divided into "Class A" and "Class B". Class A drugs are those that are necessary for clinical treatment, widely used, effective, and low-priced in the same category. Category B drugs are drugs that can be used as an option for clinical treatment, have good efficacy, and are more expensive than Category A drugs in the same category. When a participant uses a "Category A" drug, the full amount is reimbursed. When a participant uses a "Class B" drug, if the proportion of the individual's burden is not labeled, the individual must first pay 10% of the drug cost, and the rest is included in the scope of payment of the health insurance fund. If the proportion of the individual's contribution has been marked, the individual will first pay the proportion marked, and the rest will be included in the scope of payment of the medical insurance fund. No.2 What is the meaning of "Class A" and "Class B" in the catalog of diagnostic items? Diagnostic programs are divided into "Class A programs" and "Class B programs". "Class A catalog" of diagnostic and treatment items are clinically necessary, safe and effective, and appropriate cost of diagnostic and treatment items. "Category B catalog" of diagnostic and therapeutic items are available for clinical diagnosis and treatment of choice, the effect is determined, but need to control the use of appropriate diagnostic and therapeutic items. Some of the items in the "Class B catalog" are limited by clinical indications, hospital level and specialty characteristics, and qualifications of medical and technical personnel. Category A items are fully covered by reimbursement. The second category requires the individual to bear part of the cost, and the rest of the cost is included in the reimbursement scope. In order for you to Category B project reimbursement regulations have a clearer understanding Little Wu to give you a few examples Fixed payment of diagnostic and treatment projects Example 1 Tertiary hospital general outpatient medical service fee of 50 yuan, individual payment of 10 yuan, the medical insurance fund to pay 40 yuan; Example 2 Triple bed fee of 60 yuan, the first personal burden 10 yuan, the remaining 50 yuan The individual pays 10 yuan, and the remaining 50 yuan is included in the reimbursement. Proportionate personal burden of diagnostic and treatment items Example 1 head X-ray computerized tomography (CT) scanning 135 yuan / time, the individual first 8%, the rest of the cost of reimbursement into the scope of reimbursement; Example 2 stereotactic radiotherapy device refers to: Gamma Knife (r-knife) 16,000 yuan / case, the personal burden of 20%, the rest of the cost of the cost of reimbursement into the scope of reimbursement. How to check which designated hospitals have recently purchased the medicines you need Beijing Municipal Bureau of Medical Protection official website Log in to the official website of the Beijing Municipal Bureau of Medical Protection and click on the right side of the home page of the "Government Services" section. Click on the "Sunshine Medical Procurement" module on the right side of the "Government Services" section of the homepage to directly access the "Beijing Medicine Centralized Purchasing Information Network". Beijing Centralized Purchasing Information Network Log in to the Beijing Centralized Purchasing Information Network and click on "Guidelines for Drug Purchase" in the "Public Inquiry" window on the home page. Enter the name of the drug and you will be able to check the information easily.