How to reimburse categories A, B and C of medical insurance, and what does it mean for medical insur

The reimbursement ratio of medical insurance category A and category B varies from place to place.

Class A drugs will be reimbursed at 100% of the reimbursement ratio. Category B has to pay part of the self-payment and part of the reimbursement, and the specific reimbursement ratio varies according to local policies and specific drugs.

Medical Insurance Catalog. It is based on the National Essential Medicines List.

For screening, category A and B are determined according to the ratio of efficacy, that is, those with definite efficacy and low cost are included in category A and do not need to pay out of pocket. Category B basically has a self-payment ratio, and the same drug has different out-of-pocket payment ratios in different provinces and cities.

For example, the reimbursement amount for Class B drugs in Yibin City is as high as 100%. The Yibin Municipal Bureau of Human Resources and Social Security stipulates that for insured residents in the city, the township central health centers and health centers (community health service centers) that implement the zero-rate sales of basic drugs shall use the drugs in the list of essential drugs, which belong to Class B drugs, and there is no personal self-payment ratio with reference to Class A drugs.

In addition, the local labor and social security bureaus have a class B medical insurance policy.

Varieties have the right to adjust, and the total amount of transfers in and out is controlled within 15% of the number of varieties, and all localities have no right to adjust the medical insurance Class A varieties.

Extended information: In the medical insurance drug list, the Class A list is the insurance list, and the drugs in it are 100% reimbursed. It is understood that the first-class drugs in the "National Essential Medicines List" are all included in the new version of the "Drug Catalog" Class A drugs.

For the drugs in the Category B list, all localities have 15% adjustment rights. According to the affordability, each region can set a certain individual self-payment ratio for Class B drugs, and then according to the basic medical insurance.

provisions. In other words, Class B drugs may not be 100% reimbursed.

It is worth noting that workers' compensation insurance.

The maternity insurance drug catalogue is not divided into categories A and B, and all of them can be reimbursed. For anti-HIV drugs provided free of charge by the state and basic public health of the country.

The project is related to the fight against tuberculosis.

Antimalarial and anti-schistosomiasis drugs, which are used by insured persons and meet the scope of public health payment, basic medical insurance, work-related injury insurance and maternity insurance** will not be paid;

If it does not meet the scope of public health payment, basic medical insurance, work-related injury insurance and maternity insurance** shall be paid according to the regulations.

Legal analysis: medical insurance reimbursement A, B and C.

1. Category A, which can be fully reimbursed by medical insurance, is reimbursed according to the local medical insurance ratio (100%);

2. In the second category of class B, the use of such drugs requires the individual to bear part of the cost according to a certain proportion, and the remaining part will be reimbursed according to the medical insurance reimbursement scope; The social security reimbursement ratio for Class B drugs is: after the individual pays 10% first, and then reimburses in the same proportion as Class A drugs.

3. The third category of class C, this part of the medicine is not reimbursed, and all of it is borne by the individual.

4. "Class A" drugs are clinically necessary, widely used, with good efficacy, and the lowest drugs in the same category; Formulated by the state in a unified manner, all localities shall not adjust, and the expenses incurred in the use of "Class A drugs" shall be paid in accordance with the provisions of basic medical insurance.

5. "Class B" drugs are available for clinical use, with good efficacy, and are slightly higher than "Class A" drugs in similar drugs; "Category B drugs" are formulated by the state, and the provinces, municipalities and districts are appropriately adjusted according to the local economic level, medical needs and drug habits, but cannot exceed the "Category B drugs" formulated by the state, and the total number of 15 expenses unrelated to medical insurance, that is, the so-called Category C expenses, are all paid in cash.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses for emergency and rescue, and shall be paid from the basic medical insurance in accordance with national regulations.

Category A expenses are all classified as basic medical expenses; Category B has to pay 10% out of pocket, and 90% goes into basic medical expenses; Category C is self-paying.

The National Drug Catalogue of Basic Medical Insurance divides drugs into three categories:

The first category A can be fully included in the scope of medical insurance reimbursement and reimbursed according to the proportion of medical insurance;

In the second category of class B, the use of such drugs requires individuals to bear part of the cost according to a certain proportion, and the remaining part is included in the scope of medical insurance reimbursement and reimbursed according to the proportion of medical insurance;

The third category of category C, this part of the medicine is not reimbursed, all borne by the individual.

1.Class A drugs refer to drugs that are basically unified across the country and can ensure the basic clinical needs. The cost of such drugs is included in the scope of basic medical insurance** and is paid according to the standard of basic medical insurance.

2.Category B drugs refer to the basic medical insurance ** has part of the ability to pay for the cost of drugs, such drugs are first paid by the employee a certain percentage of the cost, and then included in the basic medical insurance ** payment scope, and according to the basic medical insurance payment standard to pay the cost.

3.Category A drugs refer to 100 drugs that fall within the scope of medical insurance payment;

4.Category B drugs refer to drugs that have to pay a certain percentage of their own money first, and the remaining part is covered by medical insurance.

5.But now, with the expansion and full coverage of the insured personnel, the Class A drugs for a certain group of people may be Class B drugs and Class C drugs for other groups of people, for example, in some places, all the best Western drugs for retired cadres are Class A drugs, but the Western drugs used by employees for medical treatment are divided into A, B and C, so it is necessary to analyze the specific situation.

[Legal basis].

Interim Measures for the Management of the Scope of Drug Use in Basic Medical Insurance for Urban Employees

Eighth basic medical insurance participants in the use of drugs in the drug list, the expenses incurred in accordance with the principle of the following.

The expenses incurred in the use of drugs in the "Category A Catalogue" shall be paid in accordance with the provisions of basic medical insurance. The expenses incurred in the use of drugs in the "Category B Catalog" shall be paid by the insured persons in a certain proportion first, and then paid in accordance with the provisions of basic medical insurance. The specific proportion of individual self-payment shall be prescribed by the overall planning area and reported to the labor and social security administrative departments of provinces, autonomous regions and municipalities directly under the Central Government for the record.

The expenses incurred in the use of traditional Chinese medicine decoction pieces, except for drugs that are not covered by basic medical insurance**, are paid in accordance with the provisions of basic medical insurance.

Legal analysis: 1. All Class A diagnosis and treatment items or drugs in the medical insurance level can be included in the scope of medical insurance reimbursement, and 100% of the local medical insurance ratio will be reimbursed. 2. Category B diagnosis and treatment items or drugs in the medical insurance level need to be borne by the individual according to a certain proportion of the cost, and the remaining part will be reimbursed according to the medical insurance reimbursement scope; The social security reimbursement ratio for Class B drugs is:

Individuals pay 10% first, and then reimburse in the same proportion as Class A diagnosis and treatment items or drugs. 3. Category C diagnosis and treatment items or drugs in the medical insurance level, this part of the drugs are not reimbursed, and all of them are borne by the individual.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Legal analysis: Category 1 Category A, which can be fully included in the reimbursement scope of medical hunger and hunger insurance, and will be reimbursed according to the local medical insurance ratio (100%);

In the second category of class B, the use of such drugs requires individuals to bear part of the cost according to a certain proportion, and the remaining part is included in the scope of medical insurance reimbursement and reimbursed according to the proportion of medical insurance; The social security reimbursement ratio of Class B drugs is as follows: individuals pay 10% first, and then reimburse in the same proportion as Class A drugs.

The third category of category C, this part of the medicine is not reimbursed, and all of it is borne by the individual.

"Class A" drugs are clinically necessary, widely used, have good efficacy, and are the lowest drugs in the same category; Formulated by the state in a unified manner, all localities shall not adjust, and the expenses incurred in the use of "Class A drugs" shall be paid in accordance with the provisions of basic medical insurance.

"Class B" drugs are available for clinical use, with good efficacy, and are slightly higher than those of "Class A" travel drugs; "Class B drugs" are formulated by the state, and all provinces, municipalities and districts are appropriately adjusted according to the local economic level, medical needs and drug habits, but cannot exceed the "Class B drugs" formulated by the state, and the total number of 15 expenses unrelated to medical insurance, that is, the so-called Class C expenses, are all paid by cash.