Reimbursement of rural cooperative medical care is a list issued by the hospital. Why should it be divided into three categories: A, B and C?

Any medical insurance reimbursement needs to be divided into three categories.

Medical insurance reimbursement is carried out in proportion, generally floating around 70%. The proportion and amount of reimbursement are related to their own examination and medication, medical level and other factors.

For example, it is clear that Class A (Class A) drugs can enjoy full coverage, Class C (Class C) needs to bear all the expenses, and Class B (Class B) will report 80% and bear 20% of the expenses.

Someone spent a total of 19000 yuan on medical expenses, and the reimbursement formula is as follows: (19000-500 "deductible"-self-paid medicine) *70%. If self-funded drugs account for a large proportion, there is not much amount to be reimbursed.

The unified quota of the new rural cooperative medical system belongs to the social security scope of the new rural cooperative medical system and has a unified quota standard. In 20 15 years, the maximum payment limit of the new rural cooperative medical fund will be raised to 200,000 yuan in principle. Social security A, B and C reimbursement: it belongs to the medical scope of employee social security. A, B and C refer to the reimbursement ratio of the three drugs, with 65,438+000% for Class A, 30-80% for Class B and 30% for Class C or not. ..

Extended data:

Reimbursement procedure of new rural cooperative medical system:

(1) Acceptance of the application

1. Applicant: participating patients themselves or their spouses, parents and children. If the patient can't apply in person and has no spouse, parents or children, his brother or sister will apply on his behalf; If there are no brothers or sisters, the person in charge of the villagers' committee shall apply on their behalf. Where an application is filed by an agent, a copy of the agent's ID card and proof of the relationship with the participating patients shall be submitted.

2. Accepting institutions: designated medical institutions below the county level (including the county level, the same below).

3. Application results:

(1) If the identification materials of the participating patients applying for reimbursement are true and the submitted materials are complete, they will be accepted on the spot;

(2) If there is any doubt about the identification materials of the participating patients, it shall be handed over to the cooperative medical management institution to verify their identity;

(3) If the submitted materials are not uniform, all materials that need to be supplemented shall be informed in writing at one time.

(II) Cost Accounting County-level designated medical institutions: The first-instance accountant of the cooperative medical window of county-level designated medical institutions accepts the application for reimbursement of medical expenses, reviews the materials submitted by the applicant, specifically calculates the medical expenses and compensation amount within the compensation range, fills in the Compensation Form for Hospitalization of the New Rural Cooperative Medical System, and signs the accounting opinions.

Designated medical institutions in towns and villages: the accounting personnel in the first instance of the cooperative medical service window of township hospitals accept the application for reimbursement of medical expenses, review the materials submitted by the applicants, specifically calculate the medical expenses and compensation amount within the scope of compensation, and fill out the Compensation Form for Hospitalization of New Rural Cooperative Medical System.

After signing the preliminary accounting opinions, the auditor or the full-time auditor in the township shall review the preliminary audit items and the amount of compensation, and sign the audit opinions.

(III) Payment of expenses The payment personnel at the cooperative medical window of designated medical institutions below the county level will pay the medical expenses that should be reimbursed to the applicant according to the audit opinions, and the applicant or his agent will sign the hospitalization compensation form of the new rural cooperative medical system.

Baidu encyclopedia-basic medical insurance co-ordination fund