What is the meaning of medical insurance reimbursement threshold fee

" Medical insurance reimbursement threshold fee", the standardized statement should be the basic medical insurance fund to pay the medical expenses of the participants of the " starting standard". In accordance with the principle of the health insurance system that "the health insurance fund and the participant's personal **** the same burden of medical expenses", the participant's actual medical expenses in the designated medical institution belonging to the basic medical insurance fund within the scope of the medical expenses, they have to bear a part of them first, and then the health insurance fund will pay in accordance with the prescribed proportion. The "hospitalization insurance threshold fee" is not included in the reimbursement, can only be deducted according to the patient's out-of-pocket expenses.

I. Only after the hospitalization medical expenses exceed the threshold, the part of the hospitalization medical expenses exceeding the threshold can be reimbursed according to the relevant medical insurance policy, while the hospitalization medical expenses below the threshold are to be borne by the patients themselves.

Second, the urban residents' basic medical insurance hospitalization "threshold fee" standard is: community health centers, level 1, level 2, level 3 hospitals, respectively, 100 yuan, 200 yuan, 300 yuan, 400 yuan. After the "threshold fee" is removed from the medical expenses, of which 10% is paid by the individual for Class B drugs, the remaining expenses are reimbursed at 75%, 70%, 65% and 60% by the community health centers, first-, second- and third-level hospitals respectively. However, since there are many types of social security, including basic medical insurance for urban workers, basic medical insurance for urban residents, and new rural cooperative medical insurance, the threshold cost of hospitalization insurance may also vary.

Three, the hospital level of different charges "threshold fee" standard is different, the higher the level of the "threshold fee" charged the more, the development of such a "threshold", its purpose is to guide people to reasonable medical care, the purpose of the "threshold fee" is to guide people to reasonable medical care. The purpose of setting such a "threshold" is to guide people to seek reasonable medical treatment, to prevent some patients from being hospitalized arbitrarily, so that the limited medical resources become tense, and to reduce the emergence of "minor illnesses", "should be hospitalized but can not be admitted to the hospital" and so on.

How long does it take to re-pay for a year's worth of medical insurance

1, under normal circumstances, within three months of the break in payment, the second month after the normal payment procedures, you can enjoy the normal medical insurance treatment;

2, a continuous interruption of payment for three months, will be considered as interrupted participation in the interruption of participation in the case of the desire to enjoy the medical insurance treatment, you need to be in the case of renewing the policy after the additional continuous payment of 6 months. The following is a list of the most important things that you can do to help you get the most out of the program.

Legal basis:

The People's Republic of China Social Insurance Law

Article 28

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

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.