How to calculate the medical insurance payment fees of Zhongshan Ophthalmology Department?

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How to calculate the medical insurance payment fees of Zhongshan Ophthalmology Department?

Zhongshan Ophthalmology is a well-known ophthalmic hospital located in Zhongshan City, Guangdong Province, which provides various ophthalmic diagnosis and treatment services for patients. For patients who need to purchase medical insurance, it is very important to understand the calculation method of ophthalmic medical insurance payment fees. The following will be elaborated from different perspectives.

1. Basic medical insurance expenses

The calculation of ophthalmic medical insurance costs first involves basic medical insurance costs. According to the national regulations, the basic medical insurance expenses are calculated according to the individual payment base and payment proportion. The individual contribution base is generally the average of the salary income of an individual in the previous year. The payment proportion is generally a certain proportion determined by the local and national authorities.

For example, if a patient's individual salary is 10000 yuan, the individual payment base can be determined as 10000 yuan, and the payment proportion is 10%. Then the basic medical insurance cost of the patient is 10000 yuan × 10%=1000 yuan.

2. Special diagnosis and treatment expenses of ophthalmology

The payment of ophthalmic medical insurance also includes special diagnosis and treatment expenses of ophthalmology, which refer to the expenses related to special diseases or operations of ophthalmology. According to relevant national policies, medical insurance will give certain subsidies for specific diseases or operations.

For example, a patient needs to undergo an ophthalmic operation, and the operation cost is 5000 yuan, but the medical insurance stipulates that 80% of the cost of the operation can be reimbursed. Then the special ophthalmic diagnosis and treatment cost of the patient is 5000 yuan × 20%=1000 yuan.

3. Ophthalmic medical insurance expenses for children and the elderly

The calculation of ophthalmic medical insurance costs also needs to take into account the special circumstances of children and the elderly. According to national regulations, children and the elderly enjoy certain preferential policies on medical insurance costs.

For example, a child patient needs to purchase medical insurance, and the basic medical insurance cost is 1000 yuan. According to the policy, children can enjoy 50% of the cost subsidy. Then the medical insurance cost of the child is 1000 yuan × 50%=500 yuan.

4. Other expenses

The payment of ophthalmic medical insurance may also include some other expenses, such as personal self payment, registration fees, etc. These fees are determined according to the specific policies of each hospital, and patients should carefully understand before paying.

For example, if a patient needs to purchase medical insurance, the basic medical insurance fee is 1000 yuan, and the self payment fee of 100 yuan and the registration fee of 50 yuan are also required. Then the total cost of the patient is 1000 yuan+100 yuan+50 yuan=1150 yuan.

To sum up, the calculation of Zhongshan ophthalmic medical insurance payment costs involves basic medical insurance costs, special ophthalmic diagnosis and treatment costs, preferential policies for children and the elderly, and other costs. Before purchasing medical insurance, patients should understand the calculation methods and policies of various expenses in detail so as to make correct decisions.