The standard name of the threshold fee is the Qifubiaozhun of the overall fund, that is, the Qifubiaozhun of hospitalization medical expenses for urban workers and residents. Different levels of hospitals charge different threshold fees, and the higher the level, the more threshold fees are charged. Different levels of hospitals charge different standards for "threshold fees". The higher the level, the more "threshold fees" will be charged. The purpose of establishing such a "threshold" is to guide people to seek medical treatment reasonably, prevent some patients with minor illnesses from being hospitalized at will, make limited medical resources tense, and reduce the occurrence of "minor illness cured" and "hospitalization without hospitalization".

The reimbursement ratio of hospitalization medical insurance is:

1, if it belongs to rural medical insurance, then town hospitals will reimburse 60%, secondary hospitals 40% and tertiary hospitals 30%;

2. If the party concerned belongs to urban medical insurance, the reimbursement rate of tertiary hospitals is 50%, with an upper limit of 2,000 yuan; The reimbursement rate of secondary hospitals in 300 yuan is 55%, and that of primary hospitals without Qifubiaozhun is 60%.

The scope of medical insurance includes:

1. medical insurance drug list: it is divided into Class A and Class B. All drugs in Class A list can be included in the scope of reimbursement, and then reimbursed according to the prescribed proportion; Class B drugs require individuals to pay a certain proportion, and the rest are included in the scope of reimbursement, and then reimbursed according to the prescribed proportion;

2. Catalogue of diagnosis and treatment items: diagnosis and treatment items that are necessary for clinical diagnosis and treatment, safe and effective, and have appropriate expenses, and the charging standard has been formulated by the price department. Such as: registration fee, medical record fee, beauty project, cosmetic project, etc. Cannot be reimbursed;

3. Catalogue of medical service facilities: the service facilities provided by designated medical institutions and necessary in the process of receiving diagnosis, treatment and nursing. For example, ambulance, hospitalization escort fee, shampoo fee and entertainment fee cannot be reimbursed.

I hope the above content can help you. If in doubt, please consult a professional lawyer.

Legal basis:

"Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law" Article 8.

The medical expenses incurred by the insured in the agreed medical institutions that meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards shall be paid from the basic medical insurance fund in accordance with state regulations. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.