2. The payment of the overall fund that is not recorded in the account needs to be entered into the overall fund. Co-ordination fund means that all units pay part of the fees in a public fund, and then pay the funds from this unified co-ordination fund to the insured who need to enjoy the treatment.
Overall payment standard of medical insurance
(1) The basic medical expenses incurred by the insured person during the designated outpatient time due to emergency directly to the town (street) community health service center shall be paid by the overall fund according to the regulations.
(2) the insured person directly to the town (street) community health service center outpatient rescue of basic medical expenses, the overall fund to pay in accordance with the provisions; The proportion of basic medical expenses for outpatient treatment in medical institutions other than designated outpatient service points and town (street) community health service centers will be reduced by 10%.
(3) The designated outpatient service is referred to the community health service center, and the overall fund is paid as required; Transferred to the outpatient department of the town (street) designated hospital headquarters or the outpatient department of the municipal designated specialized hospital headquarters, the proportion of overall fund payment decreased by10%; Transfer to the outpatient department of the designated tertiary hospital in the city, and the payment ratio will be reduced by 20%; Transferred to other medical institutions, the overall fund will not be paid.
(4) In addition to the above situation, the insured person goes to a medical institution other than the designated outpatient clinic for medical treatment, and the overall fund will not pay.
Legal basis:
Social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.