The medical insurance reimbursement ceiling actually refers to the upper limit of the total expenses that the medical insurance fund can reimburse you.

For the medical insurance capping line, the standards of each city are different, not uniform, and the capping lines of employee medical insurance and resident medical insurance are different. Take Beijing as an example. At present, the top line of hospitalization reimbursement for urban and rural residents and urban workers in Beijing is 2, yuan and 3, yuan respectively.

when the company pays for insurance, the medical insurance fee we pay actually includes two parts. One is the basic medical insurance premium, and the other is the large medical insurance premium.

The simple explanation is that the basic medical insurance reimburses the medical expenses under normal circumstances, while the large medical insurance reimburses the part of the expenses incurred by the insured due to serious illness that has exceeded the reimbursement limit of the basic medical insurance.

Extended information:

Reasons for setting up deductible line and capping line

1. The purpose of setting up deductible line for medical insurance fund to pay hospitalization expenses of insured persons is twofold:

1. It embodies the principle of medical insurance system reform that "insured persons and medical insurance fund share hospitalization expenses reasonably";

2. economically restrain the behaviors of wasting medical expenses such as crowding out outpatients, minor illnesses and raising children.

Second, setting up deductible line is to prevent someone from solving the problems that can be solved by outpatient service through hospitalization, or converting outpatient service expenses into reimbursement of hospitalization expenses, which will waste health resources and increase the risk of medical operation.

third, the establishment of the cap line is actually to ensure the balance of payments of the medical insurance fund. When designing the medical insurance system, the overall fund cannot bear unlimited responsibilities, and those who exceed the standard should be personally responsible or solved by establishing supplementary medical insurance.

Baidu Encyclopedia-Scope of Medical Insurance Reimbursement

People's Daily Online-Beijing: The ceiling line of medical insurance hospitalization reimbursement for employees and residents is to be raised.