How to reimburse class A, class B and class C hospitalization?

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.

Class A drugs shall be reimbursed at the reimbursement rate of 100%. Class b should pay part of its own expenses and reimburse part of it. The specific reimbursement ratio varies according to local policies and specific drugs. The medical insurance catalogue is selected according to the national essential drugs catalogue, and Class A and Class B are determined according to the price ratio of curative effect, that is to say, those with exact curative effect and low cost are all included in Class A, and there is no need to pay out of pocket, while Class B basically has a self-pay ratio, and the self-pay ratio of the same drug is different in different provinces and cities.

What are the conditions for medical insurance reimbursement?

1. In order to obtain medical insurance reimbursement for medical behavior in designated institutions, first of all, the insured person needs to see a doctor or buy medicine in designated medical institutions and pharmacies stipulated by the basic medical insurance in order to obtain reimbursement, otherwise it cannot be reimbursed;

2. If it belongs to the social security catalogue, it is necessary to have medical treatment items or purchased drugs in the social security catalogue to be reimbursed, otherwise it cannot be reimbursed;

3. To reach the deductible standard, medical insurance reimbursement is required. First, the medical expenses incurred by the insured reach the deductible line stipulated by social security, and the part exceeding the deductible line can only be reimbursed within the limit, and the unified proportion is paid by the basic medical pooling fund.

To sum up, medical insurance drugs are divided into three categories: A, B and C, all of which can be reimbursed according to the local medical insurance proportion (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.

Legal basis:

Article 41 of the Regulations of People's Republic of China (PRC) Municipality on the Basic Medical Insurance for Urban Workers.

The provincial labor and social security administrative department shall, in accordance with the relevant provisions of the state, determine the basic medical insurance drug list in conjunction with the planning, economy, trade, finance, health administration and drug supervision and management departments.

The provincial labor and social security administrative department shall, in accordance with the relevant provisions of the state, jointly with the planning, finance, health administration and drug supervision and management departments, determine the basic medical insurance diagnosis and treatment project directory, the scope of medical service facilities and payment standards.

The use of drugs, medical treatment projects and medical service facilities that are not included in the basic medical insurance coverage will not be paid by the overall fund.