What are the differences between class A medicine and class B?How to calculate the reimbursement amount?The answer is here

With the comprehensive coverage and continuous development of the basic medical insurance system, medical insurance provides a better guarantee for our lives and effectively reduces the economic burden brought by the disease. Category B's "two different reimbursement ratios, the difference between the science of the Municipal Medical Insurance Bureau, how to calculate the reimbursement amount.

Definition of "Class A medicine" and "Class B medicine"

Class A drug: Clinical treatment is necessary, widely used, good efficacy, low prices in similar drugs. When the insured uses such drugs, it can be fully included in the reimbursement scope and reimbursed according to the prescribed proportion.

Class B drugs: It can be used for clinical treatment and use, good effect, and drugs with higher prices than category A drug. When the insured uses category B drugs, after deducting a certain personal payment fee in proportion (specified in various places), the remaining expenses will be included in the reimbursement scope and reimbursed according to the prescribed proportion.

Why are the reimbursement ratio different?

Due to the different levels of medical insurance funding from all over my country, in order to ensure the basic medical drugs of insured persons, the "Basic Medical Insurance Drug Catalog" is divided into category A directory and class B directory management. Essence For graded medication and improve resource efficiency.

Class A drugs are reimbursed proportionally. Class B medicine is partially paid, and the reimbursement is different. The specific reimbursement ratio is different according to local policies and specific drugs (taking Harbin as an example, most of the medical expenses incurred by category B drugs will be paid by individual first).

How to calculate the reimbursement of Class A and B?

After the insured, the cost of medicine, diagnosis and treatment occurred, and the medicines include category A and Class B drugs. Then the method of reimbursement is: the cost of deducting the payment after the payment is deducted, and the total cost of type A medicine is added. Coupled with the expenses of medical insurance regulations such as diagnosis and treatment. For the cost of paying more than the starting line, according to the patient's own insurance type, the medical hospital level, etc.

The calculation formula is as follows: the amount of medical insurance reimbursement = (all costs of class A drug+the cost of the deduction of the type B drug+other expenses that meet the prescribed medical insurance regulations) -Thefaying line × corresponding reimbursement ratio.

For example, Liu Harbin -town, an old -fashioned employee Liu of Harbin, medical treatment of the Three A Hospital. The cost of diagnosis and treatment within the medical insurance catalog was 3,000 yuan, the cost of category A drugs was 2,000 yuan, and the cost of category B drugs was 2,000 yuan (the proportion of self -payment for this time was all the proportion It is 20%), the starting line is 720 yuan, and the reimbursement ratio of urban employee medical insurance at this level hospital is 90%.

Then the reimbursement method is: the total cost of type A drugs is 2,000 yuan, plus the remaining cost of the category B drug for 1,600 yuan (the paid part of the category B drug is 2000 × 20%= 400 yuan). The prescribed cost of diagnosis and treatment is 3,000 yuan, totaling 6,600 yuan. The cost of deducting 720 yuan, the cost of incorporating the reimbursement is 5880 yuan.

Then this time Lao Liu's medical expenses, medical insurance can reimburse 5880 × 90%= 5292 yuan, Lao Liu himself only needs to bear 1708 yuan (720 yuan from the starting line+ type B payment of 400 yuan+ medical insurance policy scope to be proportioned by proportion by proportion by proportion by proportion. Personal burden 588 yuan)

Source: Bingcheng+Client

Reporter Yu Yonglan

PSAs

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