Do I need to get a refund if the hospitalization fee is lower than the threshold fee?

If the hospitalization fee is lower than the threshold fee, the fee is borne by the patient and is not refundable, and the medical insurance patients who are below the threshold fee cannot be reimbursed.

Taking Zhengzhou as an example, according to Article 28 of the Measures for Basic Medical Insurance for Employees in Zhengzhou, the expenses incurred by the insured persons in designated medical institutions that meet the requirements shall be borne by the individual.

The minimum payment standard is determined according to different types of designated medical institutions: 200 yuan for community health service institutions (including township health centers, the same below), 300 yuan for first-class medical institutions, 600 yuan for second-class medical institutions, and 900 yuan for third-class medical institutions. If the insured person is hospitalized again after being discharged from the hospital within the same natural year, the minimum payment standard will be reduced by 50%.

The standards for the categories of designated medical institutions shall be formulated by the administrative departments for human resources and social security, and the social insurance agencies shall determine the categories of medical institutions according to the standards for the categories of designated medical institutions.

If the refund is not made, the medical insurance center will only reimburse the expenses between the "minimum payment line" and the "maximum payment line" according to the regulations, and the part of the expenses below the "minimum payment line" shall be borne by the patients themselves.

"Threshold fee" is an inaccurate statement, and the accurate title is "overall ** minimum payment standard" or "minimum payment line". It is not an additional fee charged by the medical insurance center or hospital to inpatients, but a bottom line for reimbursement of medical expenses by insured persons stipulated in relevant policies.

The so-called hospitalization threshold fee refers to all hospitalizations, the threshold fee is the minimum hospitalization consumption, that is to say, no matter how much the hospitalization fee is, this money must be deducted, but in reality, the hospitalization fee is almost zero below the threshold fee, and it is impossible to refund it to you or unless you do not go through the hospitalization procedures.

You mean below the threshold, right? If that's what you're talking about, it's very clear to you: you can't go back! If there is no accumulation below the threshold amount, how do you reach the reimbursement "position"? It's like building a building, there is no 3rd floor where the building ** comes?

It's hard to imagine such a situation!

Is the threshold fee for medical insurance required for each hospitalization? It's still the first time you need to be hospitalized, please ask. Is there a special medical insurance threshold fee app? If it is before hospitalization, it is not required.

In the case of other health insurance, will the amount of the threshold fee still be recovered? Is it a threshold fee paid before hospitalization, and it has to be paid to the Health Insurance Bureau every time later? The problem of NCMS and home insurance must belong to the first hospitalization, and the threshold fee will definitely not belong to your reimbursement, but the threshold fee will not be reimbursed by you, but you do not need to pay the next period after the threshold fee is reimbursed.

Hope this can be helpful to you, and if you have any other questions, you can also send me a private message. Yes, it must be paid before hospitalization.

First ask how many medical insurance benefits can be reimbursed by the threshold fee, and then ask the specific situationAnyway, as a medical insurance administrator, I don't care how many years you pay the threshold fee this year, the key is that you have to pay, understand? Go to see people's explanations, understand the threshold fee as a kind of hospitalization reimbursement, the threshold fee is generally aimed at patients with reduced mobility, or the elderly, these people pay relatively little expenses, otherwise, which disease is reimbursed, this can only be said to be the scope of a certain disease, as long as the medical record shows that the mobility is inconvenient, the threshold fee can only be reimbursed after paying the medical insurance threshold fee, and it must be paid every time you are hospitalized, but after the medical insurance is reimbursed, you have to pay it every time you are hospitalized.

The so-called threshold fee is the deductible, and the expenses below the deductible are not reimbursed and do not need to be paid, but the deductible will be subtracted and the expenses will be reimbursed when reimbursed.

Recalculated the following year.

Employee work-related injury, should be identified as work-related injury, after the identification of work-related injury, medical expenses are all paid by work-related injury insurance, can not use medical insurance, medical insurance is the use of ** employee illness or non-work-related injury, if there is no work-related injury identification, or is not a work-related injury, can only be reimbursed by medical insurance 1, in accordance with the provisions of the "Social Insurance Law", basic medical insurance and work-related injury insurance are different types of insurance, basic medical insurance is to protect the basic medical needs of employees due to illness or non-work-related injuries (mainly used for general outpatient services, emergency, hospitalization, etc.), and work-related injury insurance is to ensure that employees who are injured by accidents or suffer from occupational diseases due to work receive medical treatment and economic compensation. 2. In accordance with the provisions of the "Regulations on Work-related Injury Insurance", if an employee is injured by an accident at work, the unit shall report to the local labor administrative department for work-related injury identification within one month, and if it is identified as a work-related injury, the labor ability will be assessed after the injury is stabilized, and the corresponding work-related injury treatment (such as hospital meal subsidy, nursing expenses, wages during the period of suspension of work, one-time disability subsidy, etc.) shall be carried out according to the assessed disability level.

Legal analysis: The threshold fee is a popular name for the common people, but in fact, the definition of national medical insurance is called the starting line. The minimum payment of medical insurance is the minimum payment standard of "basic medical insurance".

First, the standard for the amount of inpatient medical expenses borne by the individual is the "starting line" for medical insurance to pay the inpatient medical expenses of the insured. Hospitalization expenses below the threshold shall be borne by the patient. Second, in accordance with the principle of the reform of the basic medical insurance system of "medical insurance ** and the insured person jointly bear the difference between the hospitalization medical expenses", the insured personnel in the designated medical institutions actually incurred within the scope of the basic medical insurance "catalog" of hospitalization medical expenses, they must bear a part of the first, and the medical insurance ** will be paid according to the prescribed proportion.

The role of medical insurance: it is conducive to improving labor productivity and promoting the development of production. Adjust income differences and reflect social equity.

Medical insurance adjusts income differentials by levying medical insurance premiums and reimbursing medical insurance service fees, which is an important means of income redistribution. An important guarantee for maintaining social stability. Medical insurance provides financial help to patients, helps to alleviate the social instability caused by diseases, and is an important mechanism for regulating social relations and social contradictions.

An important means to promote social civilization and progress. The social system of medical insurance and social mutual assistance is to share the risk of medical expenses among the insured, reflecting the new social relationship of "one party is in trouble, all parties support", which is conducive to promoting social civilization and progress. It is an important guarantee for promoting the reform of the economic system, especially the reform of the welfare of state-owned enterprises.

Legal basis: Social Insurance Law of the People's Republic of China

Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employees shall jointly pay the basic medical insurance premiums in accordance with the provisions of the State.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

Article 24: The State is to establish and improve a new type of rural cooperative medical system.

The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

Summary. Hello, dear, this is reasonable. Threshold fee - the minimum payment standard is commonly referred to as the "threshold", which is before the overall payment, a certain amount of medical expenses must be borne by the individual according to the regulations, and only the cost that exceeds the "threshold" can be paid by the overall payment.

The purpose of setting up the minimum payment standard is to guide residents to see outpatient clinics for minor illnesses and enter hospitals for major illnesses, so as to prevent major treatment of minor illnesses, so as to save limited medical insurance co-ordination**, and focus on ensuring serious illness medical treatment and chronic disease outpatient clinics**. At present, both the medical insurance for urban residents and the medical insurance for urban employees are implementing the minimum payment standard for hospitalization.

What is the threshold fee and is the threshold fee charged by the hospital reasonable?

Hello, dear, this is reasonable. Threshold fee - the minimum payment standard is commonly referred to as the "threshold", which is before the overall payment, according to the regulations, a certain amount of medical expenses must be borne by the individual, and only the cost of exceeding the "threshold" can be paid by the overall payment. The purpose of setting up the minimum payment standard is to guide residents to see outpatient clinics for minor illnesses and enter the hospital for major illnesses, so as to prevent minor illnesses from being treated, so as to save limited medical insurance and focus on ensuring serious illness medical treatment and chronic disease outpatient clinics.

At present, both the medical insurance for urban residents and the medical insurance for urban employees are implementing the minimum payment standard for hospitalization.

Article 28 of the full text of the Social Insurance Law of the People's Republic of China in accordance with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **. Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit. The social insurance administrative department and the health administrative department shall establish a settlement system for the cost of medical treatment in different places, so as to facilitate the insured to enjoy the basic medical insurance benefits.

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**: (A) shall be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall be borne by public health; (4) Seeking medical treatment outside the country. Medical expenses shall be borne by the third party in accordance with the law, and the third party does not pay or cannot determine the third party's shengqin, which shall be paid in advance by the basic medical insurance**.

After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

Is the threshold fee for medical insurance required for each hospitalization? It's still the first time you need to pay for hospitalization.

You have to pay it every time. Medical insurance patients who are hospitalized in the same hospital for the second hospitalization still need to pay the threshold fee, that is, the starting line, but the starting line for the second admission will be reduced by 50%. If it is an employee medical insurance, the starting line is within one year, the second hospitalization is less than the first hospitalization, and the third is less than the second, and it is reduced step by step.

I hope it will be helpful to you<>