What is the scope of social security category A and B

In the three major catalogs of health insurance, the catalogs of medicines and treatment items are divided into "Category A" and "Category B." The scope of reimbursement for medicines and treatment items corresponding to "Category A" and "Category B" is different. The scope of reimbursement for drugs and diagnostic and therapeutic programs corresponding to "Class A" and "Class B" is different.

No.1

What does "Class A" and "Class B" mean 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 therapeutic items are clinically necessary, safe, effective, and cost appropriate diagnostic and therapeutic 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 to allow you to

reimbursement of Category B items

have a clearer understanding

here

to give you a few examples

fixed payment of diagnostic and treatment items

Example 1 -

tertiary hospitals general outpatient medical service fee of 50 yuan, the individual to pay 10 yuan, the health insurance fund to pay 40 yuan;

Example 2 -

Triple Room bed fee of 60 yuan, the individual first 10 yuan, the remaining 50 yuan into the scope of reimbursement.

Proportionate individual first bear the burden of diagnosis and treatment items

Example 1-

head X-ray computerized tomography (CT) scanning 135 yuan / time, the individual first bear 8%, the rest of the cost into the reimbursement scope;

Example 2-

stereotactic radiotherapy device refers to: Gamma Knife (r-knife) 16,000 yuan / case, the individual first bear 20%, the rest of the cost into the reimbursement scope. The remaining costs are included in the scope of reimbursement.