What does Medicare hospitalization threshold mean?

Answer: Hello and kiss, according to the number of hospitalizations per year (more than 1 time the threshold fee will be halved). For medical insurance hospitalization, the total cost is 10% of the total cost excluding the self-paid part and the first 10% of the category B expenses, and the part that exceeds the hospital's medical insurance threshold fee will enjoy the overall payment ratio. The threshold fee is different for different levels of hospitals, and the proportion of people enjoying the overall payment is also different.

More than 80 percent of employees have medical insurance, and about 70 percent have domestic medical insurance.

Under normal circumstances, the employee medical insurance is 1,000 yuan, and the resident medical insurance is 600 yuan. This is the standard of a tertiary hospital, and if the hospital grade is low, then the threshold will also be lowered.

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 medical insurance threshold is the minimum payment standard for "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 personally bear the hospitalization medical expenses", the insured personnel in the designated medical institutions actually occur 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.

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Legal analysis: The hospitalization threshold fee is the starting line for hospitalization reimbursement, and the accurate title is "the overall ** minimum payment standard" or "the minimum payment remorse delay line".

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the standards of basic medical insurance drug lists, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance shall be settled directly by the social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should 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 if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.