No reimbursement after the medical insurance pooling fund is used up means that the medical insurance pooling fund has been reimbursed. As for the medical insurance pooling fund reimbursement ratio, if the medical insurance pooling fund reimbursement rate reaches 100%, then the remaining part needs to be borne by the insured.
Taking Beijing as an example, the portion above the threshold paid by the medical insurance pooling fund requires an individual to pay more than 8,000 yuan out-of-pocket before it can be reimbursed.
Individuals bear 20% and 10% respectively for Class A drugs and Class B drugs, and the maximum payment limit of the annual overall fund is 100,000 yuan.
If your medical expenses exceed the deductible, the overall fund will only reimburse the excess, and you will have to bear the shortfall.
It should be noted that medical insurance co-ordination payment and medical insurance reimbursement are different concepts.
Medical insurance pooling fund payment refers to the eligible medical expenses stipulated in the medical insurance policy, and medical insurance reimbursement refers to the part of the expenses stipulated in the medical insurance policy that are not reimbursed by medical insurance.
Why can’t I use medical insurance pooling?
There are two reasons why your medical insurance card does not enjoy the pooling reimbursement. One is that you have already enjoyed the pooled reimbursement this year and reached the maximum limit. Everyone is entitled to a fixed amount of medical insurance pooling every year. Once the quota is reached, you will no longer enjoy it. The other reason is that your workplace
If you fail to pay medical insurance fees in time, you will not be able to enjoy the medical insurance pooling fund and can only use the balance of your personal medical insurance account. You can go to the local medical insurance center to find out what the reason is for you. If the employer fails to pay, you can supervise the employer and
Pay and do not affect personal use.
To sum up, it is not that the money in your card has been used up, the rest of the money is paid by yourself. Medical insurance hospitalization is after deducting the deductible, and the remaining part will be reimbursed to you according to a certain proportion. Of course, if you don’t have any money in your card
If you have money, you can only bear the part you have to pay in cash. If you are not hospitalized, you have to bear all the expenses yourself and will not be reimbursed. Outpatient services are not included in the scope of reimbursement.
Legal basis: Article 27 of the "Social Insurance Law of the People's Republic of China": Individuals participating in the basic medical insurance for employees who have accumulated contributions for the number of years specified by the state when they reach the statutory retirement age will no longer pay basic medical insurance premiums after retirement.
Enjoy basic medical insurance benefits in accordance with national regulations; those who have not reached the nationally prescribed years can pay premiums up to the nationally prescribed years.
Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.