The money in the personal account of the medical insurance card is used up and must be borne by the individual. Personal conceit has accumulated more than the specified amount. If the medical expenses exceed the specified amount, the individual shall bear it according to different proportions according to the hospital category, and the rest shall be paid by the overall fund.

Methods of coordinating account reimbursement:

1. When purchasing medicine, the cardholder will go to the designated medical insurance institution to purchase medicine, and the expenses will be paid by the personal account;

Medical insurance is divided into two accounts, personal account and medical insurance card. The money can be used to buy medicine at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses that the individual pays. The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account;

2. Go to the outpatient clinic and keep the original diagnosis certificate, medical records, report forms and expense receipts. And go to the local social security agency for reimbursement;

When seeking medical treatment, show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, and the individual does not need to pay first and then reimburse;

3, when in hospital, first deposit a certain amount, when discharged from hospital according to the proportion of medical insurance reimbursement for payment and settlement, refund more and make up less;

There is a deductible for hospitalization reimbursement, which means that you need to pay the deductible, and the part that exceeds the deductible can be reimbursed according to local medical insurance regulations. The reimbursement rate varies from place to place, about 75%.

Overall reimbursement ratio of medical insurance:

1, medical expenses incurred in tertiary hospitals:

(1) The minimum payment is 30,000 yuan, 85% is paid by the overall fund, and15% is paid by employees;

(2) For the part exceeding 30,000 yuan to 40,000 yuan, 90% shall be paid by the overall fund and10% by the employees;

(3) For the part exceeding 40,000 yuan, the overall fund will pay 95% and the employees will pay 5%.

2. The secondary hospital medical expenses:

(1) The minimum payment is 30,000 yuan, 87% is paid by the overall fund, and13% is paid by employees;

(two) more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 92%, 8% workers pay;

(3) For the part exceeding 40,000 yuan, the overall fund will pay 97% and the employees will pay 3%.

3. Medical expenses incurred by first-class hospitals and family beds:

(1) 90% of the minimum threshold is 30,000 yuan, and 90% is paid by the overall fund and10% by the employees;

(two) more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 95%, workers pay 5%;

(3) For the part exceeding 40,000 yuan, the overall fund will pay 97% and the employees will pay 3%.

4. The individual contribution ratio of retirees is 60% of the employees.

To sum up, the maximum amount paid by the basic medical insurance pooling fund in proportion shall not exceed about 4 times of the average salary of employees in this city in the previous year.

Legal basis:

Article 29 of People's Republic of China (PRC) Social Insurance Law

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.

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.