Deductible is the amount after reimbursement by health insurance?

The deductible is the amount of money that is reimbursed by your health insurance.

The deductible is the amount of medical expenses that the insured actually incurs, but for which the insurance company will not pay. The deductible is not counted as part of the medical insurance reimbursement, but usually the insurance company reimburses the remaining amount after the medical insurance reimbursement, which is counted as part of the deductible. The deductible for the most common million-dollar medical insurance policies on the market is usually $10,000, which means that the insurance company will only reimburse the insured for out-of-pocket expenses over $10,000 during the one-year period of the medical insurance coverage. The out-of-pocket amount is the amount after Social Security reimbursement. For example, if a person gets sick and spends 40,000 yuan on treatment in the hospital, Social Security can reimburse 70 percent of that amount, or 28,000 yuan, and the remaining 12,000 yuan, after the deductible of 10,000 yuan, can be reimbursed by the insurance company for 2,000 yuan, leaving a final out-of-pocket payment of only 10,000 yuan.

There are several forms of deductibles:

1. Absolute Deductible: Before the insurer makes a claim, the insured has to pay a certain amount of loss out of pocket. For example, if the contract stipulates that the absolute deductible is 200 yuan, the loss of less than 200 yuan, the insurer will not claim. If the loss exceeds $200, the insurer pays for the excess. Generally, this deductible is applied to each loss.

2, the total deductible: is the insurance period all belong to the insurance liability of the loss is added together, if the total loss is less than the total deductible, the insurer does not pay any compensation. Once the total loss exceeds the total deductible, the insurer pays for all excess losses. A calendar year aggregate deductible is often used in health insurance, where all eligible medical expenses for the calendar year are totaled together, and once the total exceeds a certain amount, the insurer is contractually obligated to pay health insurance benefits.

3. Relative Deductible: It is a kind of deductible often used in marine transportation insurance, and the deductible is expressed as two percentages or a certain amount. If the loss is lower than the specified percentage or amount, the insurer will not be liable for compensation, but when the loss is higher than the specified percentage or amount, the insurer will compensate for all the losses. The reason why marine transportation insurance use relative deductible is because the shipper can anticipate that due to bad weather, the ship continues to sail and cargo often move at least some small losses, but also because the property is occupied by the carrier, it does not have the incentive to exaggerate the loss.

4, the disappearing deductible: according to the disappearing deductible, the deductible with the loss increases and decreases. This is effectively no payment for small losses and full compensation for large losses. For example, assuming that $500 for the starting point of the disappearing deductible, the insurer for more than $500 more than the amount of the claim to 111% compensation; when the loss reaches a certain amount, the deductible disappears.

In summary: the deductible is set to raise the threshold of claims, but also to ensure the stability of the product and control the claim rate.

Legal basis:

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

Article 23

Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employing unit and the employees in accordance with the state regulations***.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.