What's the difference between outpatient deductible and inpatient deductible?

The difference between outpatient deductible and inpatient deductible is as follows:

1, the calculation method is different: the outpatient deductible line is calculated for one year, and then the deductible line is different according to the region, medical institution, outpatient service or hospitalization. However, the hospitalization deductible line is the number of hospitalizations within one year, and the hospitalization deductible line gradually decreases until it drops to 0;

2. Different payment standards: the outpatient deductible refers to the part reimbursed by the medical insurance fund according to the regulations and in proportion, while the inpatient deductible refers to the part that should be borne by the individual, which is the money paid by the individual before the medical insurance fund is reimbursed.

Conditions of medical insurance:

1, eligible for medical insurance. Medical insurance qualifications include basic medical insurance for urban workers, basic medical insurance for urban and rural residents, new rural cooperative medical care and other types, and different types of medical insurance qualifications may be different;

2. Pay medical insurance premiums. Medical insurance participants need to pay medical insurance premiums according to regulations, which can be paid by themselves or remitted by the unit;

3. Provide relevant certificates and materials. Medical insurance applicants need to provide identification and related documents, such as ID card, household registration book, social security card, etc. , and provide medical insurance related medical expenses list and diagnosis certificate;

4. Meet the prescribed medical insurance reimbursement standards. Different types of medical insurance qualifications have different medical insurance reimbursement standards, and they need to meet the prescribed medical insurance reimbursement standards to enjoy medical insurance services.

To sum up, there are differences in calculation methods and payment standards between outpatient deductible line and inpatient deductible line.

Legal basis:

Article 26 of People's Republic of China (PRC) Social Insurance Law

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.