Which categories of A, B and C can't be reimbursed?

Class C cannot be reimbursed, and Class B can be reimbursed.

1. The use of social insurance drugs is divided into three categories: A, B and C:

The first category A can all enter the scope of medical insurance reimbursement and be reimbursed according to the proportion of medical insurance;

The second category B, the use of such drugs requires individuals to bear part of the expenses according to a certain proportion, and the rest will enter the scope of medical insurance reimbursement and be reimbursed according to the proportion of medical insurance;

Class III and Class C, these drugs are not reimbursed, and all of them are borne by individuals.

2. The concept of drugs A, B and C.

1. class a: drugs listed in class a are necessary for clinical treatment, widely used and have good curative effect, and their prices are lower among similar drugs.

2. Class B: Drugs listed in Class B are available for clinical use with good curative effect, and the price of similar drugs is slightly higher than that of Class A. ..

3. Class C: Class C is a clinically unnecessary and expensive drug except the above two categories.

Three. Methodology

1. The Category A Catalogue is formulated by the state and may not be adjusted in any place.

2 "Class B Catalogue" shall be formulated by the state, and all provinces, autonomous regions and municipalities directly under the Central Government may make appropriate adjustments according to the local economic level, medical needs and medication habits. The sum of the number of varieties increased or decreased shall not exceed 15% of the total number of drugs in the Class B Catalogue formulated by the state.

3. People who don't belong to Class A and Class B belong to Class C. ..

4. Is there a difference between Class A, Class B and Class C medical insurance reimbursement?

1. Different colors: In the medical insurance catalogue, although Class A and Class B are OTC, their colors are different. Class A is usually marked in red, and Class B is marked in green.

2. Different sales channels: Class A drugs are usually sold only in pharmacies, while Class B drugs will have more sales channels, such as pharmacies, merchants and other approved places.

3. Reimbursement ratio: Class A drugs have the best reimbursement ratio, which can achieve 100% reimbursement, while Class A drugs require the insured to pay part of the expenses and can only achieve about 80% reimbursement; Class c is not reimbursed at all.

4. Different prices: Class A drugs are uniformly formulated by the state, and the prices are relatively low; The price of Class B can be adjusted everywhere, which is higher than that of Class A; Class C is not formulated by the state, so the price level varies greatly, and the cost of some specific drugs will be much higher.

5. How do Class A, Class B and Class C report medical insurance reimbursement respectively?

Medical insurance reimbursement is not directly reimbursed according to the proportion of Class A and B reimbursement, but only according to the part that enters the basic medical expenses and is higher than the deductible standard. The specific reimbursement process is as follows:

1. Hospitalization settlement: After hospitalization, the insured person needs to make discharge settlement in the hospital, which is generally paid by himself or his unit.

2. Reimbursement: After advance payment, the insured person will go to the local social medical insurance agency for settlement with relevant medical information and bills.

3. Reimbursement expenses are received: for those who meet the reimbursement conditions, the medical insurance agency will return the relevant reimbursement expenses to the insured's account after the audit is completed, and complete this reimbursement.

legal ground

Interim Measures for the Administration of the Medication Scope of the Basic Medical Insurance for Urban Employees

Article 7 The Catalogue of Class A shall be formulated by the state and may not be adjusted in any place. The "Category B Catalogue" is formulated by the state, and all provinces, autonomous regions and municipalities directly under the Central Government may make appropriate adjustments according to the local economic level, medical needs and drug use habits. The sum of the number of varieties increased or decreased shall not exceed 15% of the total number of drugs in the Class B Catalogue formulated by the state.

Provinces, autonomous regions and municipalities directly under the central government may, according to clinical indications and hospital levels, restrict drugs that are easy to be abused and have great toxic and side effects in the drug list and Class B list of the province (autonomous region or municipality directly under the central government).

Interim Measures for the Administration of the Medication Scope of the Basic Medical Insurance for Urban Employees

Eighth basic medical insurance insured to use the "Drug List" drugs, the expenses incurred by the payment according to the following principles.

The expenses incurred in using Class A drugs shall be paid in accordance with the provisions of the basic medical insurance. The expenses incurred in the use of "Category B drugs" shall be paid by the insured according to a certain proportion, and then according to the provisions of the basic medical insurance. The specific proportion of individual pays shall be stipulated by the overall planning area and reported to the administrative departments of labor security of provinces, autonomous regions and municipalities directly under the Central Government for the record.

The expenses incurred in the use of Chinese herbal pieces shall be paid in accordance with the provisions of the basic medical insurance, except for drugs that are not paid by the basic medical insurance fund.