Any reimbursement for health insurance needs to be reimbursed in such three categories.
Medicare reimbursements are made on a sliding scale, usually fluctuating around 70%. The percentage and amount of reimbursement has to do with your tests and medications, level of care, and other factors.
An example would be clearer: Class A (Category A) medicines are fully reimbursed, while Class C (Category C) requires full out-of-pocket expenses, and Class B (Category B) is reimbursed at 80 percent, with an out-of-pocket percentage of 20 percent.
Someone who spends a total of 19,000 yuan on medicine, and the reimbursement formula is like this: (19,000-500 "starting line" - out-of-pocket expenses) * 70%, if the out-of-pocket expenses take up a large proportion of the medicine, the reimbursement down is not much of an amount.
New rural cooperative unity limit belongs to the social security scope of the new rural cooperative, there is a unified limited standard, in 2015 the new rural cooperative integrated fund maximum payment limit in principle increased to 200,000 yuan. Social security a b c reimbursement: belongs to the employee social security medical scope, a b c refers to the reimbursement ratio of the three categories of drugs, a category can be 100% full report, category b can only report 30-80%, category c can only report 30% or not report.
Expanded information:
New rural cooperative reimbursement procedures:
(a) Application acceptance
1, the applicant: the participating patients themselves, or their spouses, parents, children. If the patient cannot apply in person and does not have a spouse, parent or child, his/her brother or sister shall apply on his/her behalf; if he/she does not have a brother or sister, the person in charge of the village committee shall apply on his/her behalf. If the application is made by his/her agent, a copy of the agent's ID card and proof of his/her relationship with the patient shall be submitted.
2. Accepting organization: the designated medical institutions below the county level (including the county level, the same below).
3, application results:
(1) application for reimbursement of the patient's identity documents are true, the submission of complete materials, shall be accepted;
(2) the patient's identity documents are in doubt, shall be transferred to the cooperative medical management agency to verify their identity;
(3) the submission of incomplete materials, shall be a one-time written notice of the need to all the materials to be made up.
(2) cost accounting county-level fixed-point medical institutions: the county-level fixed-point medical institutions cooperative medical window preliminary accounting staff accept applications for reimbursement of medical expenses, review the materials submitted by the applicant, the specific accounting of compensation within the scope of the cost of medicine and the amount of compensation, and fill in the New Rural Cooperative Medical Care Hospitalization Compensation Form, signing the accounting opinion.
Township designated medical institutions: the township health center cooperative medical window initial accounting staff accept applications for reimbursement of medical expenses, review the materials submitted by the applicant, specifically accounting for compensation within the scope of the medical expenses and compensation amount, and fill out the "New Rural Cooperative Medical Care Hospitalization Compensation Form".
After signing the preliminary accounting opinion, the reviewer or township full-time auditor examines the preliminary items and compensation amount and signs the audit opinion.
(C) the cost of payment by the designated medical institutions below the county level cooperative medical window payment personnel in accordance with the audit opinion, to the applicant should be reimbursed for the payment of medical expenses, and signed by the applicant or his agent in the New Rural Cooperative Medical Care Hospitalization Compensation Form.
Baidu Encyclopedia-Basic Medical Insurance Co-ordination Fund