What does the deductible line of medical insurance for urban and rural residents mean?

What does the deductible line of medical insurance for urban and rural residents mean?

What does the deductible line of medical insurance for urban and rural residents mean? The basic medical insurance for urban residents is highly subsidized. Individuals only pay part of the premium, and the government subsidizes most of the expenses, thus reducing the burden on families. What does the deductible line of medical insurance for urban and rural residents mean?

What does the deductible line of medical insurance for urban and rural residents mean? 1 1. The deductible line of medical insurance for urban and rural residents is what people call the threshold fee.

That is to say, when the insured enjoys medical insurance benefits, he needs to bear part of the medical expenses first, and deduct the medical expenses other than his own, which is the medical expenses that medical insurance should reimburse the insured.

The maximum amount of medical expenses borne by individuals is the deductible line of medical insurance for urban and rural residents.

Second, the medical insurance capping line for urban and rural residents is the highest standard for the insured to enjoy medical insurance benefits and reimbursement expenses, which is called the medical insurance capping line for urban and rural residents, also called the maximum reimbursement amount.

Three, in 2022, the designated hospitals for urban and rural residents' medical insurance deductible line and capping line, local regulations are different.

If Tianjin is taken as an example, in 2022, the deductible line and capping line of Tianjin designated hospitals for urban and rural residents' medical insurance are as follows:

(1) the first, second and third level designated hospitals outpatient and emergency deductible in 600 yuan.

The deductible line of hospitalization year is around 500 yuan.

② The annual capping line of outpatient and emergency departments in first-,second-and third-level designated hospitals is around 4,000 yuan.

The annual hospitalization capping line is about 6.5438+0.8 million yuan.

What other expenses in daily life are not reimbursed by medical insurance?

Medical items that do not belong to the treatment category are generally not reimbursed, such as cosmetic surgery, height increase and other medical beauty aspects; Diet pills, hangover drugs, etc. There are also some special needs during hospitalization, such as entertainment activities, extra expenses for hiring nurses, etc. In addition to the above, it is particularly important to note that the ambulance fee cannot be reimbursed.

What does the deductible line of medical insurance for urban and rural residents mean? 2. In 2022, the medical insurance payment of urban and rural residents in the province can be paid.

320 yuan began to pay 202 1 in September. The National Health Insurance Bureau, together with the Ministry of Finance and State Taxation Administration of The People's Republic of China, issued the Notice on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 20021year, stipulating that the per capita financial subsidy standard for medical insurance for urban and rural residents will be raised in 30 yuan in 2022, reaching no less than that of 580 yuan per person per year; At the same time, raise the individual payment standard of residents' medical insurance in 40 yuan, and reach the 320 yuan per person per year.

Insurance payment process

According to the process of registration before payment.

1. insured persons in this county: 202 1 those who have been insured in various counties and districts may not apply for insurance registration, and pay directly after confirming that the identity information of the insured person is correct.

2. New insured: you need to bring your valid ID card, household registration book and social security card to the township (or community) where your household registration is located.

3. Insured persons outside the county: If you need to be insured in your county, you need to contact the medical insurance department of the original insured place to delete the insurance information, and then go to the medical insurance department of your county to go through the insurance registration procedures.

4. Newborns: ① For newborns born in that year, the guardian shall register and pay the insurance for the newborns in that year within 90 days (inclusive) from the date of birth, and enjoy the treatment from the date of birth to 65438+ February 3 1 day of that year. (2) If a newborn born from June 10 to February 3 1 0 fails to participate in the insurance payment in the current year due to household registration and other problems, the guardian can register the insurance payment for the next year within 90 days (inclusive) from the date of birth, and enjoy the benefits from June 12 3 1 day.

Payment channel

(a) The Government charges the system. Urban and rural residents can pay insurance premiums to rural medical insurance managers and pay them centrally through the tax collection system.

(2) Designate commercial banks to pay the fees. Urban and rural residents can hold valid ID cards or household registration books to pay fees at the counters of any commercial bank outlets in the county, such as agricultural banks, rural credit cooperatives and postal savings banks.

(3) self-service payment. Please consult the bank staff for the online payment method of cooperative commercial banks. Wechat and Alipay pay by themselves.

What does the deductible line of medical insurance for urban and rural residents mean? What are the conditions for medical insurance reimbursement?

Generally speaking, medical insurance reimbursement needs to meet the following conditions:

During the normal treatment, that is, when the medical insurance has not been paid off, the medical insurance reimbursement needs to conform to the scope of the three major medical insurance directories, and the medical expenses should be within the capping line above the deductible line. Expenses beyond these rules cannot be reimbursed.

What are the "three catalogues" of medical insurance?

It is the reimbursement scope of drugs, diagnosis and treatment items and medical service facilities of basic medical insurance stipulated by the medical insurance department. Those in the three catalogues can be reimbursed by medical insurance, and those not in the catalogue cannot be reimbursed.

Some drugs, diagnosis and treatment projects and medical service facilities also have limited reimbursement conditions, and they cannot be reimbursed if they do not meet the conditions.

How to calculate the cost of medical insurance reimbursement?

In the list of medical expenses and medical insurance, the expenses of class B drugs after deducting out-of-pocket expenses plus the total expenses of class A drugs, plus the medical expenses that meet the requirements of medical insurance, are added together to get the scope of medical expenses that can be reimbursed.

Within this range, the expenses that exceed the deductible and fail to reach the capping line shall be reimbursed according to the patient's own insurance and the hospital level of medical treatment.

Under what circumstances will medical insurance not be reimbursed?

Article 30 of China's Social Insurance Law stipulates that the following medical expenses are not included in the payment scope of the basic medical insurance fund:

1. shall be borne by a third party. Like fighting.

2 should be paid by the industrial injury insurance fund. Such as unfortunate accidents at work.

3. Health expenses that should be borne by the public. Prevention and immunization of some major diseases and infectious diseases.

4. Go abroad for medical treatment.