1, the overall fund is mainly used to pay for hospitalization medical expenses, outpatient medical expenses for prescribed diseases and outpatient medical expenses for major diseases;

2. Personal accounts are mainly used to pay the expenses borne by individuals in general outpatient medical expenses, drug purchase expenses and hospitalization medical expenses;

3, personal account balance is insufficient to pay, the excess part shall be borne by the individual;

4, the overall fund and individual accounts are accounted for separately, and shall not be misappropriated.

The reimbursement process of outpatient co-ordination:

1, the patient sees a doctor in a designated medical institution and shows his medical insurance card or relevant certificates;

2. After receiving treatment, part of the medical expenses will be directly settled by the medical insurance system, and the rest will be borne by the individual;

3. If the individual's annual accumulated medical expenses reach the outpatient co-ordination deductible line, you can apply for reimbursement;

4. When submitting an application for reimbursement, relevant medical expense bills and supporting materials shall be provided;

5. After the medical insurance department reviews the eligible expenses, the reimbursement amount will be transferred to the personal account or paid directly.

To sum up, the reimbursement method of outpatient co-ordination involves that the co-ordination fund mainly pays outpatient expenses for hospitalization, prescribed diseases and serious diseases, and personal accounts are used for general outpatient expenses and hospitalization expenses borne by individuals. The insufficient balance of the account shall be borne by the individual, and the overall fund and the individual account need to be accounted for separately to ensure that the funds are earmarked and cannot be misappropriated.

Legal basis:

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

essay

Establish the basic medical insurance fund for urban workers, and implement the system of combining individual medical accounts with basic medical co-ordination fund payment. The ownership of personal accounts belongs to individuals. The ownership of the overall fund belongs to all personnel participating in the basic medical insurance.

Article 28

Personal accounts are used to pay medical expenses beyond the scope of the overall fund payment; If the personal account is insufficient to pay, it shall be borne by me.

Article 29

The hospitalization medical expenses for serious and serious diseases shall be paid according to the following methods: (1) Qifubiaozhun shall be controlled in principle at 9%- 1 1% of the average social wage of employees in cities, counties and autonomous counties in the previous year. (two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year. (three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses. The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.