After the medical insurance personal account is used up, it will enter the account part, the conceited part and the negative part.
Personal account of medical insurance is referred to as personal account of basic medical insurance. Personal accounts are mainly used to record and store personal account funds and are used for personal medical consumption according to regulations. The main sources of personal account funds include: medical insurance premiums paid by individuals; A certain percentage of social medical insurance premium paid by the employer; Some include personal account start-up funds paid by employers for individuals; There is also the interest income of personal account funds generated with the increase of insurance years.
Personal account payment scope: usually used to pay the insured's specific medical expenses, including outpatient expenses incurred by designated medical institutions; Drug purchase expenditure of designated retail pharmacies; In the basic medical expenses for specific items of hospitalization and outpatient service in designated hospitals, the expenses below the Qifubiaozhun of the overall fund shall be paid; Exceeding the minimum threshold, the expenses that should be borne by individuals.
The insured person's use of personal account funds to pay medical expenses shall conform to the provisions of the scope of basic medical drugs, the scope of diagnosis and treatment projects, the scope of medical service facilities and payment standards.
According to overall management, the basic medical insurance for urban workers in China is divided into two accounts, namely, overall account and individual account. The personal account here is the medical insurance personal account.
The basic medical insurance for employees shall implement the three-level settlement method for outpatient medical expenses, namely, the account part, the self-funded part and the negative part.
In each employee's medical insurance year (1 year from May to April 30th of the following year), the personal account in the medical insurance card of that year (that is, the account part) is used for personal outpatient treatment.
When the personal account is used up, it will enter the conceited stage. According to different age groups, the conceited segment is 900 yuan under 45 years old; 45 years old (inclusive) to retired 600 yuan; 300 yuan after retirement.
The medical expenses of the individual outpatient service in medical insurance coverage during the self-sufficiency period shall be borne by the individual according to the above amount, but the medical insurance card shall be swiped every time he sees a doctor.
At present, the medical expenses within the scope of medical insurance in personal outpatient service are paid by individuals and medical insurance funds in proportion. At present, the payment standards are: 25% for individuals to seek medical treatment in tertiary hospitals and 75% for medical insurance funds; For outpatient service in community hospitals, employees bear 14%, retirees bear 8%, and medical insurance fund pays 86% and 92% respectively. Individuals who seek medical treatment in other hospitals bear 20%, and the medical insurance fund pays 80%.