What is the reimbursement scope of the medical insurance card, what is Class A drugs, what is Class B drugs, and how are they graded?

I. Reimbursement Scope of Medical Insurance

(1) Rural Medical Insurance

1. Outpatient Reimbursement:

(1) 60% reimbursement for village health clinic and village center health clinic visits, with a limit of 10 yuan for prescription medication for each visit, and 50 yuan for prescription medication for temporary rehydration of the health center doctor.

(2) Township health centers will be reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.

(3) Secondary hospitals are reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.

(4) Tertiary hospitals will reimburse 20% of the fees, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.

(5) Chinese medicine invoices with prescription attached are limited to RMB 1 yuan per sticker.

(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.

2. Hospitalization Compensation

(1) Pharmaceutical expenses: auxiliary examinations: EKG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees are limited to 200 yuan; surgical fees (with reference to the national standard, reimbursement for more than 1,000 yuan will be made in accordance with the amount of 1,000 yuan).

(2) For the elderly over 60 years old who are hospitalized in Xingta Township Health Center, the treatment fee and nursing fee are compensated at 10 yuan per day, with a limit of 200 yuan.

3. Compensation for major illnesses

(1) Compensation from the town's risk fund: Any hospitalized patient who participates in the rural cooperative medical insurance with a one-time or yearly cumulative reimbursable medical fee exceeding

5,000 yuan or more is compensated in segments, i.e., 65% for 5,001-10,000 yuan, and 70% for 10,001-18,000 yuan.

(2) The annual limit of compensation for township-level cooperative medical treatment for inpatient hospitalization and outpatient blood dialysis for uremia, and outpatient radiotherapy and chemotherapy for oncology is 11,000 yuan.

(2) Employee Health Insurance

1, diagnostic and therapeutic equipment and medical materials category

such as: application of X-ray computed tomography (CT), stereotactic radiography, cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single-photon emission computerized Scanning device (SPECT), color Doppler, medical linear gas pedal and other large-scale medical equipment for examination, treatment projects; extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy and so on.

2, treatment projects category

such as: hemodialysis, peritoneal dialysis; kidney, heart valve, cornea, skin, blood vessels, bone, bone marrow transplantation; cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects; hearing aids and other rehabilitation appliances; a variety of self-use of health care, massage, examination and rehabilitation and treatment equipment.

3, other

such as: a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; a variety of scientific research, clinical verification of the diagnosis and treatment program.

Two, the division of drugs

Based on the proportion of sales of various types of drugs listed, the classification of drugs.

Generally speaking, the proportion of sales in more than 10% of the drugs for the A class, also known as the main drugs, such as cold and flu, respiratory drugs, etc.; between 5% and 10% of the drugs for the B class, also known as auxiliary drugs, such as gynecology, antibiotics, etc.; less than 5% of the drugs for the C class, also known as the accessory drugs, such as cardiovascular, blood drugs, etc..

Category A drugs are reimbursed at the full rate, category B drugs are reimbursed at the 80 percent rate, and category C drugs require full out-of-pocket expenses.

Expanded Information

Precautions on the use of medical insurance cards

I. Prohibition of cash withdrawals

No unit or individual may violate the scope of the use of the card or the requirements of the card, and cash withdrawals are strictly prohibited.

Second, some provinces and cities medical insurance card can be used by the whole family

Since the second half of 2016, some provinces and cities, such as the province of Zhejiang, Guangzhou City, medical insurance personal account balance funds over the years can be used to pay for the basic medical insurance of employees' spouses, children, parents and other close relatives of the medical security costs, to realize the family members of the family members of the **** relief and mutual assistance.

Three, the following cases of medical insurance will not be paid

1, in the non-designated medical structure or non-designated retail pharmacy purchase of drugs (except for emergencies);

2, due to their own fights and assaults, drug abuse, or other illegal behavior caused by their own injuries;

3, due to alcoholism, suicide, self-inflicted injuries and other reasons for treatment;

4, due to Traffic accidents, medical malpractice or other responsible accidents resulting in injuries;

5. and cases that should be paid by the individual according to national or local regulations.

Baidu Encyclopedia - medical insurance reimbursement scope

Zhejiang government services network - your hands of the medical insurance card this year, but also this additional purpose!