The deductible is a prescribed limit before medical insurance reimbursement, and individuals need to bear the medical expenses below the deductible.
Deductible refers to a minimum limit set by an insurance company or medical insurance institution in medical insurance reimbursement. That is, medical expenses below this limit will not be compensated by the insurance company or medical insurance institution and must be borne by the individual.
Regarding the question of whether the deductible is before or after medical insurance reimbursement, in fact, the deductible is calculated before medical insurance reimbursement.
1. The concept and significance of deductible: Deductible is an important provision in the medical insurance system, which embodies the risk-taking principle of insurance.
By setting a deductible, insured persons can be encouraged to pay more attention to their personal health and reduce unnecessary medical expenses. It can also reduce the risk burden of insurance companies or medical insurance institutions.
2. Calculation method of deductible The calculation method of deductible is usually determined based on a certain proportion or fixed amount of the total medical expenses.
After medical expenses are incurred, the deductible will first be deducted, and the remaining portion will be reimbursed according to the medical insurance policy.
Therefore, the deductible is determined before reimbursement by medical insurance.
3. The relationship between deductible and medical insurance reimbursement Medical insurance reimbursement means that after the insured person incurs medical expenses, in accordance with the provisions of the medical insurance policy, the medical insurance institution will compensate a certain proportion or amount of the medical expenses that meet the regulations.
The deductible, as the starting point for medical expense reimbursement, determines which expenses can be reimbursed and which expenses need to be borne by the individual.
Therefore, the existence of a deductible directly affects the scope and amount of medical insurance reimbursement.
4. How to reduce the economic pressure caused by deductibles. Faced with the economic pressure caused by deductibles, insured persons can take some measures to reduce risks.
For example, you can choose to purchase higher-end medical insurance products to obtain higher reimbursement ratios and lower deductibles; at the same time, you can also focus on personal health management to prevent the occurrence of diseases and reduce medical expenses.
To sum up: the deductible is a prescribed limit before medical insurance reimbursement, and individuals need to bear the medical expenses below the deductible.
By understanding the concept, calculation method and relationship between deductibles and medical insurance reimbursement, insured persons can better understand the medical insurance system and take corresponding measures to reduce the financial pressure caused by deductibles.
Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" stipulates: Medical expenses that meet the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be covered by the basic medical insurance in accordance with national regulations.
Paid from the fund.
Article 30 stipulates: The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) Those that should be paid from the work-related injury insurance fund; (2) Those that should be borne by a third party; (3) Those that should be paid by the public ***
Those who bear health burden; (4) Those who seek medical treatment abroad.
Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first.
After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.