The medical insurance premiums paid by all employers for employees in the overall planning area are included in the overall planning account, which can be mainly used to reimburse the hospitalization medical expenses and special outpatient medical expenses incurred by the insured. Generally speaking, the medical insurance pooling fund belongs to all insured persons, which is stored in special accounts and earmarked for special purposes, and no unit or individual may misappropriate it. Corresponding to the overall medical insurance account is the personal medical insurance account. The money in the personal account mainly comes from the part paid by the staff in the medical insurance fee, which can be mainly used to pay for general outpatient service and buy medicine in designated medical institutions.
1. The overall management of medical insurance consists of individual accounts and overall accounts.
2. The basic medical expenses incurred by the insured person in the designated outpatient time directly to the town (street) community health service center for emergency treatment shall be paid by the overall fund as required.
3 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.
4. The basic medical expenses incurred in outpatient rescue of medical institutions in the city outside the designated outpatient points and town (street) community health service centers shall be reduced or exempted by 10%.
5 by the designated outpatient referral to the community health service center, the overall fund in accordance with the provisions of payment.
6. Transfer to the outpatient department of the town (street) designated hospital headquarters or the outpatient department of the municipal designated specialized hospital headquarters, and the proportion of overall fund payment will be reduced by 10%.
7. If it is transferred to the outpatient department of the headquarters of a designated tertiary hospital in the city, the payment ratio will be reduced by 20%.
8 transferred to other medical institutions, the overall fund will not be paid.
Legal basis:
People's Republic of China (PRC) Social Insurance Law Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity.
People's Republic of China (PRC) Social Insurance Law Article 3 The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
People's Republic of China (PRC) Social Insurance Law Article 4 Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights and interests records, and require social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.
People's Republic of China (PRC) Social Insurance Law Article 5 The people's governments at or above the county level shall incorporate social insurance into the national economic and social development plan. The state raises social insurance funds through multiple channels. People's governments at or above the county level shall give necessary financial support to social insurance. The state supports social insurance through preferential tax policies.