Proportion of differentiated reimbursement of Class A and B medical insurance

The differences between medical insurance A and B are as follows:

1, the reimbursement rate of Class A drugs is 100%, that is, when the insured uses Class A drugs, the expenses can be fully included in the scope of medical insurance reimbursement;

2. The reimbursement rate of Class B drugs is 70%-90%. When using Class B drugs, the insured must pay a certain proportion of the expenses before the rest can enter the scope of medical insurance reimbursement.

Classification basis of medical insurance drugs:

1. Clinical necessity of drugs: Class A drugs are usually the basic drugs to treat common diseases and frequently-occurring diseases, and play an important role in maintaining people's health;

2. Economy of drugs: Class A drugs are relatively low in price and cost-effective, while Class B drugs may be high in price, but they have special effects on some diseases;

3. Safety and effectiveness of drugs: Class A drugs are generally safe with few side effects, and their effectiveness is widely recognized;

4. National medical policy and medical insurance cost control requirements: the formulation of medical insurance catalogue will consider the needs of national medical resource allocation and medical insurance cost control.

To sum up, the reimbursement rate of Class A drugs is 100%, and that of Class B drugs is 70%-90%. Insured people have to pay a certain percentage of fees before they can enjoy medical insurance reimbursement.

Legal basis:

Notice of the Ministry of Labor and Social Security, the State Development Planning Commission and the State Economic and Trade Commission on Issuing the Interim Measures for the Administration of the Scope of Medication of 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.