Pays, deductibles, large cumulative ...... read these keywords, you only really understand Medicare reimbursement!
┃ Source: Worker's Daily
At present, China's basic medical insurance system includes basic medical insurance system.
Many workers have participated in Medicare, but related bills to Medicare hospital outpatient charges or statements not very understanding. Medicare reimbursement around the specifics vary, these keywords will be able to read quickly understand the costs of medical treatment.
Keywords 1
Personal Cash Amount:
It refers to the amount of self-pay patients need.
Keywords 2
Medical insurance fund payment amount:
It means the total cost of the medical insurance fund. They include: Outpatient large payments, insurance payments and other supplementary retirement payment.
Keywords 3
Deductible:
That Qifubiaozhun following fees, medical insurance bureau set the corresponding Qifubiaozhun depending on the category of the insured and hospital grade category.
Keywords 4
Medical insurance coverage amount:
Medicare reimbursement amount within this range of medical expenses belong.
Keywords 5
The cumulative amount within the scope of health insurance:
As of the time of this settlement costs, this year's total included within the scope of Medicare reimbursement of medical expenses.
Keywords 6
Outpatient large cumulative annual pay:
As of the time of this fee settlement, the year Medicare outpatient cumulative total for the insured person to pay costs.
Keywords 7
Individual payments, at their own expense amount:
It means the patient will pay for the amount of a pay, pays two, at their own expense the amount of the composition.
Pays a: refers to the amount of energy into the patient needs to pay medical expenses in the range of Medicare. They include: deductible amount and the amount paid exceeds the amount from the patient pays.
Pays II: Indicators Notes "partially pays" drugs, the total cost required to check the patient's own pay. Assuming that the price of 100 yuan a bottle of drugs belong pays medicines at their own expense if the ratio is 10%, then they have to bear 10 yuan. It belongs pays II.
At their own expense: Notes Indicators for the "full pay" medicines, check the total cost, the need to pay their own patients.
Beijing to Medicare patients, for example, retired outpatient costs Medicare patients pay line is 1,300 yuan, serving Medicare outpatient deductible is 1,800 yuan, which means a patient at the clinic, the cost of health insurance accumulated more than from within before they can be reimbursed after the deductible.
For chestnuts
Zhang is a working hypothesis of Medicare patients, he happened outpatient costs 2,000 yuan a tertiary hospital, which pays 100 yuan is full of drugs, the remaining 1900 yuan fall within the scope of health insurance amount (non-reimbursement of outpatient medical institutions to community 70%).
Pays a: 1800 + (1900-1800) * 30% = 1830 yuan;
Pays two: $ 0 (or partially pays drug treatment);
Fee: 100 (full pays drugs);
Eventually, the individual pays a pay = pay + two + = 1930 yuan at their own expense, insurance reimbursement 70 yuan.
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https://med.sina.com/article_detail_103_2_67689.html
Many of my friends with little security response, every time I go to the hospital to open a variety of fee bills, dense fees, see also do not understand, ask also ask do not know, you can only pay complete medication thing, home or cloud in fog, the specific pay any money? Medicare reimbursement how much? do not know either. Today, small insurance come to you to take calculate the cost of outpatient service charge bill on exactly how to come.
First, we need to understand the meaning of each item of the documents, in order to better understand their medical expenses exactly how settlement. Taking Beijing as an example of medical outpatient service charge bill
This is one of the top three hospitals in Beijing real-time billing Medicare alone, we look at the level of this part of the project. Here reimbursement level will mark this outpatient treatment costs and medical expenses, a total of three categories:
1. No pay: the cost of health insurance funds is in proportion to the full reimbursement.
2. Pays: individuals pay part of the cost of (mostly 10%), the remainder of the cost of health insurance funds pro rata reimbursement.
3. Full pays: is entirely at their own expense part of health care costs are not reimbursed.
Secondly, look at personal account to pay this part. Shown here is the use of the health insurance fund during the year:
4. The amount within the scope of health insurance: The cost is included in the total cost of health insurance can pay range.
The cumulative amount within the scope of health insurance: The cost of the settlement is the cutoff, the cumulative amount of insurance coverage within the year.
Every place has its Medicare reimbursement from the pay line to Beijing clinic, for example, in Beijing outpatient deductible is 1,800 yuan, cap line of 2 million; hospitalized in deductible is 1,300 yuan, cap line 50 million, within the scope of the annual total amount is not reached within the Medicare reimbursement deductible insurance reimbursement exceeded 1800 yuan and 20,000 yuan part of the ceiling line, Medicare is not reimbursed.
6. Annual fund accumulated large outpatient payment: This is the cut-off fee settlement, the cumulative total for the current year Medicare outpatient insured person has been reimbursed.
7. Outpatient large annual Balance: is the amount after the cut-off times when the cost of the settlement, the year Medicare also able to pay for the insured.