Medical insurance reimbursement payment limit and deductible line:
The payment limit refers to the maximum payment limit of the medical insurance fund, that is, the maximum amount of the fund that the insured can reimburse within one year.
Qifubiaozhun refers to the Qifubiaozhun of medical insurance fund. To put it simply, you are eligible for reimbursement only if you reach a certain fee when you are hospitalized. Below the deductible line, the patient will bear it, and above the deductible line, the medical insurance fund will reimburse you in proportion.
In fact, not only does medical insurance have the limitation of payment limit and deductible line, but it also happens when you buy commercial insurance every day. Therefore, everyone must see clearly the deductible and the amount of the payment limit. Many people are controversial about follow-up reimbursement because these two concepts are not clear.
The deductible refers to the deductible standard of medical insurance fund. To put it simply, when we are hospitalized, we are eligible for reimbursement only if we meet certain expenses. The patients below the deductible line shall be borne by themselves, and the part above the deductible line standard shall be reimbursed by the medical insurance fund according to the prescribed proportion.
The capping line refers to the maximum payment limit of the medical insurance fund, that is, the maximum amount of the fund that the insured can reimburse within one year.
After participating in basic medical insurance, it does not mean that you can report as much as you spend, and there is a maximum payment limit. The maximum payment limit refers to the maximum amount of medical expenses paid by the basic medical insurance fund to the insured in a medical year. At present, the standard is about four times the average wage of employees in this city last year. If the average salary of employees was 10000 yuan last year, the maximum payment limit was about 40000 yuan.
Legal basis:
Article 17 of the Social Insurance Law of People's Republic of China (PRC)
If an individual who participates in the basic old-age insurance dies due to illness or non-work, his survivors can receive funeral grants and pensions; Persons who have completely lost their ability to work due to illness or non-work-related disability before reaching the statutory retirement age can receive disability allowance. The required funds are paid from the basic old-age insurance fund.
Article 18 The state establishes a normal adjustment mechanism for basic pensions. According to the average wage increase and price increase of employees, the basic old-age insurance treatment level will be improved in a timely manner.
Nineteenth individuals across the overall regional employment, the basic old-age insurance relationship with my transfer, the cumulative payment period. When an individual reaches the statutory retirement age, the basic pension is calculated in stages and distributed uniformly. Specific measures shall be formulated by the State Council.
Article 20 The state establishes and improves a new rural social endowment insurance system.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.