1. Payline
The insured person needs to pay the deductible for hospitalization, and the standards are: first-level medical institution 100 yuan/time, second-level 300 yuan/time, and third-level 800 yuan/time.
2. Headlines
Set the maximum amount of hospitalization reimbursement for the insured. The standard is: 70,000 yuan/person/year for the first file and 1 10000 yuan/person/year for the second file.
The outpatient expenses and hospitalization expenses of major diseases in special diseases are combined to calculate the capping line.
3. Proportion of reimbursement
The medical expenses incurred by the insured in hospitalization within the scope of the insurance policy shall be reimbursed according to the following standards: level I: 80% for level I medical institutions, 60% for level II medical institutions and 40% for level III medical institutions. Second gear: 5 percentage points higher than first gear. Minors are raised by 5 percentage points on the basis of adults in the same file. "
As long as it is a designated medical insurance hospital, whether it is inside or outside the city, public or private, the above standards are uniformly implemented.
For your appendicitis, the total cost is deducted from the deductible standard, and the special materials or drugs that are not reimbursed (generally, doctors who can't reimburse you will tell you) are multiplied by the reimbursement ratio, which is basically how much you can report. Please consult the local social security bureau for details.