The hospital's deductible line is a threshold for medical insurance reimbursement, and only the part that exceeds the deductible line can be reimbursed. Therefore, if the medical expenses do not exceed the deductible, then this part of the expenses cannot be reimbursed. But if the medical expenses exceed the deductible, the excess can be reimbursed.
The deductible line and the capping line are the reimbursement standards of the medical insurance fund, as follows:
1, deductible: refers to the deductible standard of medical insurance fund. For the medical expenses incurred by the insured within the policy scope of designated medical institutions, first of all, the expenses below the Qifubiaozhun shall be borne, and the part above the Qifubiaozhun shall be reimbursed by the medical insurance fund according to the regulations and proportions. According to different regions, medical institutions, outpatient clinics or hospitalizations, the threshold is different, ranging from several hundred yuan to more than one thousand yuan.
2. Cap line: refers to the maximum payment limit of compliance fees, that is, the maximum reimbursement amount that the insured can get from the medical insurance fund within one year. Medical expenses exceeding the cap line can be solved by participating in supplementary medical insurance, critical illness insurance and commercial medical insurance.
The deductible line and the capping line have different functions and meanings in medical insurance reimbursement;
1, deductible line: deductible line is the reimbursement threshold of medical insurance fund, and only part of medical expenses exceeding deductible line can be reimbursed. This means that if the medical expenses do not reach the deductible line, the insured person needs to bear all the expenses himself. The setting of deductible line aims to reduce the burden of medical insurance fund, enhance the cost consciousness of insured and reduce the waste of medical resources.
2. Top line: The top line is the highest payment limit of the medical insurance fund, that is, the medical expenses paid by the medical insurance fund cannot exceed this limit within one year. The part exceeding the capping line needs to be borne by the insured. The setting of the capping line is to ensure the sustainable operation of the overall fund and avoid the overspending of the medical insurance fund.
To sum up, deductible line and capping line have different functions in medical insurance reimbursement. The deductible line is the threshold for reimbursement, and the capping line is the highest payment limit. The establishment of these two lines aims at balancing the burden of medical insurance funds and ensuring the basic medical needs of insured persons.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.