How much the hospital spends on medical insurance reimbursement

The amount of reimbursement depends on a number of factors, including the level of the hospital, the type of contribution (e.g., employee or urban/rural residents), and whether it is the first hospitalization.

The amount of reimbursement depends on a number of factors, including the level of the hospital, the type of contribution made by the patient (e.g., employee or urban/rural residents), and whether it is the first time the patient has been hospitalized.

Generally, hospitalization expenses are reimbursed as long as they exceed the threshold. The criteria for the starting line vary depending on the level of the hospital and the type of health insurance the patient has. For example, the starting line for a tertiary hospital may range from $600 to $2,000, while the starting line for a primary hospital may be as low as $200. Reimbursement rates also vary depending on the level of hospital and the type of insurance the patient has, with tertiary care hospitals likely to have the highest reimbursement rates and primary care hospitals having relatively low reimbursement rates.

In addition, for specific groups of people (e.g., the elderly) and for specific diseases, health insurance policies may offer additional reimbursement discounts or different threshold standards. Therefore, the exact amount that can be reimbursed needs to be calculated based on the individual's type of medical insurance, the level of hospital visited, the amount of hospitalization expenses and other factors.

How much does health insurance reimburse

1, different hospitals have different health insurance reimbursement ratios

If a person spends 10,000 yuan in the hospital, if it is in a first-class hospital inpatient hospitals, then subtract 500 yuan; if it is in a second-class hospital inpatient hospitals, then subtract 1,000 yuan; if it is in a third-class hospital inpatient hospitals, subtract 2,000 yuan; after that, subtract the first If you are hospitalized in a tertiary hospital, you will first subtract 2,000 RMB; after that, you will deduct "non-medicare medication costs" and "other non-medicare costs", leaving 80% for active employees and 50% for retired or unemployed or jobless people. Note: The health insurance reimbursement only protects Class A drugs that are used for medical insurance, Class B is not reimbursable for non-medical insurance.

2, the working staff hospitalization medical reimbursement reimbursement ratio

Medicare hospitalization, the total cost in addition to the out-of-pocket part, after the first 10% of Category B costs, more than the hospital medical insurance threshold fee, enjoy the integrated payment ratio. The hospital's threshold fee is different for different levels of hospitals, and so is the percentage of the total payment. The proportion of employee medical insurance is more than 80% (82%/84%/87% in Wuhan), and the proportion of resident medical insurance is about 70% (80%/65%/50% in Wuhan). So it seems that the proportion of medical insurance hospitalization out of their own pockets, it is not easy to say, out-of-pocket part of all out of their own pockets, the threshold fee all out of their own pockets, the cost of category B first out of their own pockets 10%, and then with the cost of category A, out of their own pockets 20% or so. It's very complicated, isn't it! In fact, the computer system will automatically calculate. Medical insurance hospitalization, show your medical card, read the card into the medical insurance system, pay the deposit (generally threshold fee), the costs incurred into the system, the system automatically categorized as out-of-pocket, Category A, Category B, etc., Category B first 10% out-of-pocket, and then into the basic medical care, in accordance with the annual number of hospitalizations (greater than 1 threshold fee is halved), the level of the hospital (threshold fee is different, the overall percentage is different), by the computer to calculate how much money should be paid by themselves, the hospital then to the social security medical center, the hospital will pay 10% out of pocket. The hospital will then bill the social security center for the amount of money.

The calculation formula is like this: if you use up medical expenses totaling 9,000 yuan, the reimbursement formula: [9,000-500 (threshold) - out-of-pocket expenses] multiplied by 80%, if the out-of-pocket expenses take up a large proportion of the reimbursement down is not much of an amount. Generally speaking, the economic development of different regions is different, so the reimbursement rate also varies, the following on the situation of the proportion of Beijing employees' medical insurance coverage.

Summary of the above is a small number of hospitals to spend how much money can go to the health insurance reimbursement of the relevant answer, I hope to be able to help you.

Legal basis

Social Insurance Law, Article 28, in line with the basic medical insurance drug catalog, diagnostic and treatment items, medical service facility standards, as well as emergency, rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.