Who is the cost of "medical insurance payment standards"?the answer is......

In the settlement of medical expenses

I often encounter a concept

"Medical Insurance Payment Standard"

Although ordinary insured persons rarely come into contact with it

But it is closely related to our medical insurance treatment

Let's take a look at it together

What is "medical insurance payment standard"?

"Medical Insurance Payment Standards" refers to the benchmark for basic medical insurance funds when using medical insurance projects with basic medical insurance participants. The parts within the payment standard shall be shared by the insured and the medical insurance fund in proportion, and the parts other than the payment standard shall be paid by the insured.

To put it simply, for some medical insurance projects, the medical insurance department will designate the amount of a medical insurance payment. The money within this amount shall be borne by the medical insurance and the insured as the reimbursement, and the amount of money needs to be resolved by the insured themselves.

In the case that the drugs, consumables or services purchased by the patient are elected or negotiated products, the amount of payment of medical insurance is the price of the patient bought the medicine. Essence For example, some very expensive negotiating medicines, the standard of medical insurance payment is the uniform price of the country. How much is how much is to sell the price when selling it to patients, then reimburse according to the prescribed proportion. But sometimes, for example, when the collection of drugs, patients may be a little higher than the medical insurance payment standards when purchasing non -secondary drugs under the same universal name. At this time, it involves calculations that exceed the amount of payment standards.

Cases about "medical insurance payment standards"

The ibuprofen capsule produced by a manufacturer belongs to the category A in the medical insurance directory, and is determined to be a non -secondary variety for the fourth batch of national centralized band purchases. The price is 10 yuan/box, and the medical insurance payment standard is 8 yuan/box. Then, when using the drug, the 2 yuan that exceeds the medical insurance payment standard is paid by the insured patients, and the 8 yuan within the medical insurance payment standard shall be borne by the insured and the medical insurance fund according to the reimbursement ratio of Class A medicine.

Which medical insurance projects have "medical insurance payment standards"?

Not all projects have medical insurance payment standards.

At present, only when negotiated drugs, procurement of drugs, "two diseases", drugs, and purchase of medical consumables and some medical service projects will be provided by the medical insurance department to have a unified medical insurance payment standard. When using these projects, the reimbursement amount of patients will be calculated according to the medical insurance payment standard. In addition, the projects will be reimbursed directly according to the relevant reimbursement level.

If you have any questions about medical insurance policies and related businesses, you can call the corresponding consultation of the corresponding place in the insurance place. (O working day, from Monday to Friday, 8:30 am, from 2:30 pm to 5:30 pm))

Municipal Medical Insurance Center (Municipal Direct) 0758-2108809

Duanzhou District 2227290, 2261373

Dinghu District 2699279, 6629804, 6629805

Gaoyao District 8352005 (urban and rural) 8351187 (employee)

Sihui City 3395611, 3395228 (urban and rural)

3118760, 3118762 (employee)

Guangning County 8669892 (urban and rural) 8638339 (employee)

Deqing County 7763705 (urban and rural) 7768333 (employee)

7863888, 7796328

Seng Kai County 6668612 (urban and rural) 6687572 (employee)

Huaiji County 5568991

High -tech Zone 3103268

Source: Zhaoqing Medical Security

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