Are hospitals reimbursed for starting line money

Hospitals are reimbursed for the cost of their starting line.

The hospital's starting line is a threshold for reimbursement by Medicare, and only the portion that exceeds the starting line is reimbursed. Therefore, if the medical expenses do not exceed the threshold, then that portion of the expense is not reimbursable. However, if the medical expenses exceed the threshold, then the excess can be reimbursed.

The starting line and the ceiling line are the reimbursement standards of the health insurance fund, which are as follows. When a participant incurs medical expenses within the scope of the policy in a designated medical institution, he/she has to bear the expenses below the threshold first, and then the part above the threshold will be reimbursed by the medical insurance fund according to the regulations and proportions. Depending on the region, medical institution, outpatient clinic or hospitalization, the starting standard varies from a few hundred yuan to more than a thousand yuan.

2. Capping line: This refers to the maximum payment limit for compliant expenses, that is, the maximum amount of reimbursement that a participant can receive from the health insurance fund in a year. For medical expenses beyond the cap line, participants can solve them by joining supplementary medical insurance, major illness insurance, commercial medical insurance and other methods.

The starting line and the ceiling line have different roles and meanings in health insurance reimbursement:

1. Starting line: The starting line is the threshold for reimbursement by the health insurance fund, and only the portion of the medical expenses that exceeds the starting line can be reimbursed. This means that if the medical costs do not reach the threshold, the insured person has to bear the entire cost himself. The setting of the starting line aims to reduce the burden on the health insurance fund, enhance participants' awareness of costs and reduce the waste of medical resources.

2. Capping line: The capping line is the maximum payment limit of the medical insurance fund, that is, the medical expenses paid by the medical insurance fund cannot exceed this limit in a year. Participants are responsible for the portion that exceeds the cap line. The capping line is set to ensure the sustainable operation of the pooled fund and to avoid overspending of the health insurance fund.

In summary, the starting line and the ceiling line play different roles in medical insurance reimbursement. The starting line is the reimbursement threshold, while the capping line is the maximum payment limit. These two lines are set to balance the burden on the health insurance fund and protect the basic medical needs of the insured.

Legal basis:

The Law of the People's Republic of China on Social Insurance

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.