What's the meaning of the minimum amount of the deposit
I hope to adopt it
For the first hospitalization in a medical year, the starting line should be controlled at about 5% - 10% of the average annual salary of local employees in principle. The starting line is closely related to the hospital level and hospitalization times. The higher the hospital level is, the higher the starting line is. The lower the hospital level is, the lower the starting line is. In the same medical year, the starting line decreases with the increase of hospitalization times. Generally speaking, the starting line is no longer charged for the fourth hospitalization in the same medical year
extended data:
the expenses within the starting line are borne by indivials, which are higher than the expenses of the starting line (excluding the part of self funded drugs). After the money of the starting line is removed, the medical insurance will reimbursement according to the specified proportion
The medical expenses below the starting line were paid by the participating farmers themselves. According to the policies of different cities, there may be a minimum payment line for chronic diseases, and there may also be a minimum payment line for general outpatient services of urban residentsThe minimum payment standard refers to the minimum payment line of "basic medical security", and refers to the amount that is not accepted when insurance claims are settled< br />
2. Are we all at a loss when the total cost of medical insurance reimbursement reaches the minimum payment line? In fact, social security will pay part of your social security money into your health insurance account, and this part of the money can be used to make up the starting line. Taking the following table as an example, it is assumed that social security will be paid based on the 2014 social average wage
3. Is it possible to apply for reimbursement if you spend more than 1800 yuan in the outpatient department? This is not necessarily because we need to add up the reimbursable part of the outpatient expenses. For example, when the reimbursement part of the inspection expenses and the reimbursement part of some drugs in the outpatient expenses (the fully self paid drugs are not reimbursable, the self paid drugs are 70% to 80%, and the non self paid drugs are 100%) reach 1800 yuan, After that, the out-patient expenses in the medical insurance can be reimbursed. At this time, the out-patient expenses often exceed 1800 yuan
4. How to apply for reimbursement when the reimbursable expenses of outpatient service for urban employees exceed 1800 yuan? The outpatient expenses over 1800 yuan less the minimum payment line (1800 yuan) and the non reimbursement items, and the non reimbursement part of the indivial's all paid drugs and self paid drugs, will be reimbursed according to the corresponding proportion of medical insurance reimbursement (90% of the reimbursement in the city's community and 70% in other designated areas) Reimbursement.
Starting line is a method of social medical insurance expenses and service reimbursement in social insurance. It refers to the insured after medical expenses, first pay a certain amount of medical expenses, beyond the amount of medical expenses paid by the medical insurance agency
the actual hospitalization expenses of the insured in the designated medical institutions are within the scope of the "Catalogue" of basic medical insurance, and the amount standard of hospitalization expenses borne by indivials first is the "starting line" of medical insurance fund to pay the hospitalization expenses of the insured. The inpatient medical expenses below the starting payment standard shall be borne by the patient himself
extended data
the original intention of the design of the starting line is to set a cost threshold ring hospitalization, so as to prevent the insured from "transferring from outpatient to inpatient" and avoid serious illness. According to the types of insured personnel, there are different standards for urban residents' starting payment standard and reimbursement proportion:
1. Students and children
in the settlement year, the starting payment standard of tertiary hospitals is 500 yuan, and the reimbursement proportion is 55%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 60%; There is no minimum payment standard in the first-class hospitals, and the reimbursement rate is 65%
2. For the elderly over the age of 70, if the medical expenses less than 100000 yuan in line with the reimbursement scope occur in the settlement year, the standard of the third level hospital is 500 yuan, and the reimbursement proportion is 50%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 60%; There is no minimum payment standard in the first-class hospitals, and the reimbursement rate is 65%
3. In the settlement year of other urban residents,
in case of medical expenses less than 100000 yuan in line with the reimbursement scope, the third level hospital should pay 500 yuan as the starting standard, and the reimbursement proportion is 50%; The minimum payment standard of secondary hospital is 300 yuan, and the reimbursement proportion is 55%; There is no minimum payment standard in the first-class hospitals, and the reimbursement rate is 60%
Dectible, also known as dectible (commonly known as threshold fee), is the starting point for calculating the compensation of cooperative medical fund for participating farmers. The medical expenses below the starting line shall be paid by the participating farmers themselves
for the first hospitalization in a medical year, the starting line should be controlled at about 5% - 10% of the average annual salary of local employees in principle
The higher the hospital level is, the higher the starting line is. The lower the hospital level is, the lower the starting line is. In the same medical year, the starting line decreases with the increase of hospitalization times. Generally speaking, the starting line is no longer charged for the fourth hospitalization in the same medical yearaccording to the policies of different cities, there may be a minimum payment line for chronic diseases, and there may be a minimum payment line for general outpatient service of urban residents
extended data:
characteristics of the starting line of medical insurance:
first, the medical expenses below the starting line are borne by the patients or shared by the patients and their units, which enhances the insured's awareness of expenses and helps to rece waste
Secondly, a large number of small medical expenses are excluded from the reimbursement scope of medical insurance, which reces the workload of insurance settlement and reces the management cost The third is that the insured should bear the small expenses, which is helpful to protect the risk of disease with high expenses, that is, to protect the serious diseaseI can't explain Hangzhou's specific policies to you. Let's Take Nanjing as an example. I hope you can understand that the reason is the same.
inpatients in Nanjing have different minimum payment standards (commonly known as threshold line) in different designated medical institutions, which is 1000 yuan in tertiary medical institutions, The second level medical institution is 650 yuan, and the first level or no level medical institution is 400 yuan.
the starting payment standard is the medical expense sharing mechanism formulated by the local agencies according to the local reality.
your medical expenses this time are less, just beyond the starting payment standard, so the actual reimbursement amount is less
The minimum payment standard refers to the minimum payment line of "basic medical security", and refers to the amount that is not accepted when insurance claims are settled
The minimum payment standard is not determined by the hospital, but by the medical insurance agencyaccording to the basic medical insurance system reform principle of "the medical insurance fund and the insured indivial jointly bear the hospitalization medical expenses", the insured personnel should bear part of the hospitalization medical expenses within the scope of the "directory" of the basic medical insurance in the designated medical institutions before the medical insurance fund pays according to the specified proportion
the amount standard of hospitalization medical expenses that indivials bear first is the "starting standard" for medical insurance fund to pay the hospitalization medical expenses of the insured. The inpatient medical expenses below the starting payment standard shall be borne by the patient himself
extended data:
the starting standard of basic medical insurance for urban residents means that the expenses above the starting standard will be reimbursed in proportion, and the expenses below the starting standard will be borne by indivials
reimbursement percentage of basic medical insurance for urban residents
1. For class I designated medical institutions (including community health service institutions), the overall fund payment is 60%, and the indivial bears 40%
2. For class II designated medical institutions, the overall fund payment is 55%, and the indivial bears 45%
3. For class III designated medical institutions, the overall fund payment is 50%, and the indivial bears 50%
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