How to reimburse Class A, B and C drug medical insurance?

The first category A can all enter the scope of medical insurance reimbursement and be reimbursed according to the local medical insurance ratio (100%); 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; The proportion of social security reimbursement for Class B drugs is: individual pays first 10%, and then reimburses according to the proportion of Class A drugs. Class III and Class C, these drugs are not reimbursed, and all of them are borne by individuals. The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Medical insurance drugs are divided into three categories: A, B and C. All Class A drugs can enter the scope of medical insurance reimbursement and be reimbursed according to the local medical insurance ratio (100%); After the individual needs to pay 10% in advance for Class B drugs, the remaining 90% can be co-ordinated by outpatient service, 45% by chronic diseases, and 90% by chronic diseases; 100% Class C drugs pay by themselves and cannot be co-ordinated.

How to classify medical insurance A, B and C?

1, class a drugs

It is necessary for clinical treatment, widely used, good in curative effect and low in price among similar drugs. When the insured uses such drugs, they can all be included in the scope of reimbursement and reimbursed according to the prescribed proportion;

2. Class B drugs

It can be used in clinical treatment with good curative effect and higher price than similar class A drugs. When using Class B drugs, the insured must first deduct a certain amount of personal out-of-pocket expenses according to the proportion (local regulations), and then include the remaining expenses in the scope of reimbursement, and reimburse them according to the prescribed proportion;

3. Class C drugs

Basic medical care is not covered, and most areas need personal payment 100%. Of course, some areas may also be reimbursed. See the column of "self-care ratio" in the hospital invoice for details. Class C drugs generally include: health care products, high-grade drugs, newly developed drugs, imported anticancer drugs, etc.

In short, most hospitals will mark the "self-care ratio" of each drug, medical materials, examination, laboratory test and other expenses on the invoice or hospitalization bill, regardless of class A, class B, class C, outpatient service or hospitalization. If not specified, the hospital may be a "non-medical insurance designated hospital".

Legal basis:

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

Article 8

The expenses incurred by the insured of the basic medical insurance in using the drugs in the Drug List shall be paid 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.