What is the reimbursement scope of the medical insurance card, what are Class A drugs, what are Class B drugs, and how are their levels divided?

Category A drugs can enjoy full coverage, while category C drugs need to be fully self-paid, while category B drugs require 80% of the coverage and 20% of the cost.

1. Outpatient compensation:

(1) 60% reimbursement for village clinics and village center clinics, with a limit of 10 yuan for prescription drugs per visit, and temporary rehydration prescription drugs by doctors at the health center The fee limit is 50 yuan.

(2) The town health center reimburses 40% of the fees for each visit, with a limit of 50 yuan for examination fees and surgical fees, and a limit of 100 yuan for prescription drugs.

(3) 30% reimbursement for visits to secondary hospitals, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.

(4) 20% reimbursement for visits to tertiary hospitals, with a limit of 50 yuan for examination fees and surgical fees for each visit, and a limit of 200 yuan for prescription drugs.

(5) There is a limit of 1 yuan per prescription attached to the traditional Chinese medicine invoice.

(6) The annual compensation limit for town-level cooperative medical outpatient clinics is 5,000 yuan.

2. Hospitalization compensation

(1) Scope of reimbursement:

A. Medication expenses: auxiliary examinations: electrocardiogram, X-ray, film, Laboratory tests, physical therapy, acupuncture, CT, MRI and other examinations

The examination fee limit is 200 yuan; the operation fee (refer to the national standard, if it exceeds 1,000 yuan, it will be reimbursed at 1,000 yuan).

B. For elderly people over 60 years old who are hospitalized in Xingta Town Health Center, treatment and nursing fees will be compensated 10 yuan per day, with a limit of 200 yuan.

(2) Reimbursement ratio: 60% is reimbursed by the town health center; 40% is reimbursed by the second-level hospital; 30% is reimbursed by the third-level hospital.

3. Compensation for serious illness

(1) Town risk fund compensation: All inpatients who participate in rural cooperative medical insurance will have a one-time or annual cumulative medical expense of more than

For above 5,000 yuan, compensation is divided into sections, that is, 65% compensation for 5,001-10,000 yuan, and 70% compensation for 10,001-18,000 yuan.

(2) The annual limit of compensation for town-level cooperative medical inpatient and uremia outpatient hemodialysis, cancer outpatient radiotherapy and chemotherapy is 11,000 yuan.

Extended information:

Not included in the reimbursement scope of rural cooperative medical insurance:

1. Seeking medical treatment on your own (not designated hospital for medical treatment or no referral form), Self-purchased drugs, drugs that cannot be reimbursed by public medical regulations and medical expenses that do not comply with family planning;

2. Outpatient treatment fees, house calls, hospitalization fees, meals, companionship fees, nutrition fees, and blood transfusion fees (Except for those with family blood banks, which will be reimbursed according to relevant regulations), heating and cooling fees, ambulance fees, special care fees and other expenses;

3. Car accidents, fights, suicide, alcoholism, work-related accidents and medical accidents Medical expenses;

4. Orthopedics, plastic surgery, dentures, prostheses, organ transplants, surgical fees, consultation fees, etc.;

5. Within the scope of reimbursement, the portion beyond the limit.

Baidu Encyclopedia - Medical insurance reimbursement scope