Self-payment ratio of social security class B drugs

The out-of-pocket proportion of social security class B drugs is 10%.

Details are as follows:

1, the individual pays 10% first, and then reimburses according to the same proportion of Class A drugs;

2. Class B medical insurance drugs need to be borne by themselves (most of them are 10%-20% conceited) with a certain proportion (there are differences between drugs);

3. Class B drugs are available for clinical use, with good curative effect and higher price than Class A drugs in similar drugs. The proportion of individual self-payment for Class B drugs shall be uniformly formulated by all overall planning areas and reported to the provincial human resources and social security department for the record.

The scope of medical insurance reimbursement includes:

1, medical expenses during rescue;

2. Medical expenses during hospitalization;

3, surgical materials and AIDS;

4. Bed fee: according to local medical insurance standards. Except those who need to stay in ICU (intensive care unit) because of acute craniocerebral injury and complex visceral injury coma, but they should be transferred to the general ward immediately after they are out of danger;

5. Rehabilitation physiotherapy fee: according to local medical insurance standards. In principle, there are no more than three kinds, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated;

6, dressing change and rehabilitation function guidance training: according to local medical insurance standards combined with disease needs;

7. Ambulance fee: calculated according to the standard approved by local health department and price department;

8. Other expenses: expenses that are not compensated according to regulations will not be compensated;

9. Continuing medical expenses: In order to close the case in advance, the insured can pay the necessary continuing medical expenses for the injured in the future in advance. Only when the discharge certificate or diagnosis certificate clearly indicates that the competent doctor needs to continue treatment, or the internal fixator is removed after half a year or one year, or the follow-up treatment expenses are reviewed or recorded regularly, and the compensation payment voucher provided by the insurance record for the follow-up expenses can be reviewed. According to the needs of the disease, obviously beyond the needs of the disease, the audit fee for continuing medical treatment will not be compensated.

To sum up, Class B drugs require the insured to bear part of the expenses according to a certain proportion (that is, "individual pays first"), and the rest expenses are reimbursed in proportion.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

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.