What do you mean by deductible?

The meaning of deductible is as follows:

Deductible is a concept in medical insurance, which refers to a certain amount that the insured needs to pay in advance in the actual medical expenses of medical institutions, and the expenses beyond this amount can be reimbursed by the medical insurance fund. The deductible line is set to prevent the abuse of medical resources and encourage the insured to use medical services reasonably. Different levels of hospitals and different types of insured people have different qifubiaozhun and reimbursement ratio. For example, for students and children, the deductible line of tertiary hospitals may be 500 yuan, while the deductible line of primary hospitals may not be set. In addition, for the elderly over 70 years old, the deductible and reimbursement ratio are also different. Under normal circumstances, there is no deductible line in the general outpatient department of grass-roots public medical institutions, and the proportion of reimbursement is high. It is more economical to go to grass-roots medical institutions for some common minor illnesses.

Calculation method of deductible:

1. Calculated on the basis of individual's annual accumulated medical expenses: deductible usually means that medical insurance will reimburse the individual only after the accumulated medical expenses reach a certain amount within a certain period of time (such as one year);

2. The influence of regional differences: the deductible line may be different in different regions, which is usually determined by the local socio-economic level and medical insurance policy;

3. Difference of insured persons: The deductible line may be different according to different insured persons (such as urban workers and urban and rural residents). );

4. Influence of medical service type: The deductible line may be different according to the type of medical service (such as outpatient service and hospitalization);

5. Annual adjustment: The deductible line can be adjusted every year according to the change of medical expenses and the adjustment of medical policies.

To sum up, deductible is the threshold for controlling resource abuse and encouraging reasonable medical treatment in medical insurance, and its standard varies according to the level of the hospital and the type of the insured. For example, tertiary hospitals set the deductible line for students in 500 yuan, while primary hospitals may not have this restriction. At the same time, the elderly enjoy different deductible lines and reimbursement policies, while primary medical institutions usually do not set deductible lines to provide a higher reimbursement ratio and reduce the cost of medical treatment for minor illnesses.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 25

The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.