Category A refers to Class A drugs required for clinical treatment. They are widely used in the same category of drugs with good efficacy and low prices. The expenses incurred in using these drugs should be included in the payment scope of the basic medical insurance fund and paid in accordance with the rules. 100% of Class A drugs will be reimbursed according to the reimbursement ratio. Category B refers to Class B drugs. The basic medical insurance fund can cover the cost of some medicines. When medical insurance reimburses the expenses incurred for using the drug, the drugs in the drug catalog are divided into "Category A" and "Category B". Category A refers to Category A drugs required for clinical treatment.
Reimbursement categories and certification materials:
1. Transfer for medical treatment outside the hospital: The formalities for transfer for medical treatment outside the hospital must be reported. If the condition is urgent, the transfer procedures should be completed within 7 days;
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2. Resettlement and work in another place: it is required to live and work in another place for more than half a year, and registration procedures must be completed in advance;
3. Medical treatment during short-term outings such as business trips, family visits, and tourism Fees: ① Acute diseases: Provide business trip certificates, family visit certificates, outbound travel contracts, real-name air tickets, etc. when reimbursing; ② Outpatient maintenance treatment of chronic diseases: increase the medical records provided for Xiamen outpatient treatment, and the diagnosis and treatment measures during the period away from home cannot exceed the original diagnosis and treatment measures in Xiamen; < /p>
4. Delivery in another place: hospital delivery expenses and reasonable prenatal and postpartum examination expenses;
5. Failure of the social security system in local and integrated areas cannot be settled by credit card in real time: charges will be charged by medical institutions Apply for invoice endorsement certificate and stamp;
6. Report loss or damage of social security card, delay in card issuance: Social Security Card Management Department stamps the back of the invoice for confirmation;
7. Single month of outpatient service The number of visits exceeds 20: the bill must be settled by card and show the number of registrations, and outpatient records must be provided;
8. Acute illness or rescue without a social security card: outpatient or inpatient medical records should be recorded in detail and clearly. It is enough to be recognized as an acute disease or rescue;
9. Expenses for drugs outside the catalog for retired cadres: "Approval form for drugs outside the catalog for retired cadres" must be provided and stamped with the official seal of the hospital's medical insurance management department; Cadre health care subjects must provide health care certificates;
10. Insured status, change, change of insured unit, delay in arrival of local tax data: after completing the change procedures at the local tax and confirming the arrival in the middle of the next month, Apply for reimbursement;
11. Medical expenses for newborns starting from birth: Insurance enrollment and payment should be made promptly within three months of birth, and reimbursement can only be made after the payment is received. A birth certificate must be provided; for newborns who are not named when expenses are incurred, the name on medical expense invoices, summary lists, discharge records and other reimbursement documents shall be the mother's or father's name followed by "son" or "daughter".
To sum up, Class A drugs refer to drugs that are uniformly formulated, necessary for clinical treatment, widely used, good in efficacy, and low-priced among similar drugs. The expenses incurred by using such drugs are included in basic medical care. The insurance fund payment scope is based on basic medical insurance; Class B drugs are drugs that can be used for clinical treatment, have good curative effects, and are more expensive than Class A drugs among similar drugs.
Legal basis:
Article 28 of the "Social Insurance Law of the People's Republic of China"
Comply with the basic medical insurance drug catalog, diagnosis and treatment items, Standards of medical service facilities and medical expenses for emergency and rescue services shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29
The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit .
The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.