Is the health insurance cap of 300,000 for life or for one year

Medicare is capped at 300,000 per year, and the cap is actually the upper limit of the total amount of expenses that can be reimbursed by the health insurance fund. For the health insurance cap line, the standard of each city is different, not uniform, and the employee health insurance and resident health insurance cap line are different. The cap is the total amount reimbursed in a year.

The maximum reimbursement amount refers to the cumulative payments made in a health insurance year. The maximum hospitalization reimbursement limit for urban workers' medical insurance is 300,000 yuan, which is respectively 100,000 yuan for the maximum payment limit of the basic medical insurance fund and 200,000 yuan for the cumulative maximum payment limit of the large amount of mutual aid funds.

Despite the fact that the state has stipulated that medical insurance can reimburse medical expenses, there is still a part of the medical insurance is not reimbursed, this part of the cost of what?

1, the service category:

Registration fee, medical records cost, etc.; clinic fees, examination and treatment of expedited fees, name surgery surcharge, self-requested special nurses and other special medical services.

2. Diagnostic and therapeutic equipment and medically useful materials:

Application of large-scale medical equipment such as electron beam CT, ophthalmic excimer laser treatment instrument for examination and treatment programs. Eyeglasses, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitative devices, a variety of self-use therapeutic equipment.

3, treatment project category:

Organ source or tissue source for all kinds of organ or tissue transplantation; other organs or tissue transplantation except kidney, heart valve, cornea, skin, blood vessel, bone, bone marrow transplantation; myopic eye orthopedics; qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other auxiliary therapeutic projects.

So, the reimbursement rate of health insurance, the specific reimbursement limit is different in different areas, and at this time also consider whether it is an outpatient or hospitalization, but in general the amount of insurance in the case of hospitalization is much better.

Legal Basis

The Social Insurance Law of the People's Republic of China

Article 2: The State establishes a social insurance system for basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., to safeguard the right of citizens to obtain material assistance from the State and society in accordance with the law in the event of old age, illness, industrial injury, unemployment and maternity, etc. The State has established a social insurance system to protect the rights of citizens to obtain material assistance from the State and society.

Article 26 The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.