According to relevant management regulations, the out-of-pocket ratio refers to the percentage of medical expenses paid by the insured in the form of medical cost sharing in which the medical insurance institution and the patient jointly bear the costs.

The so-called personal out-of-pocket ratio refers to the proportion of medical expenses allowed to be paid by the medical insurance policy that is borne by the insured person.

The out-of-pocket ratio refers to the amount of money spent on medical treatment, part of which must be paid out of pocket.

The medical insurance deductible ratio is 0, which means that no individual payment is required, and all medical insurance expenses are paid by the pool.

The self-pay ratio refers to the percentage of medical expenses paid by the insured that is borne by the insured in the form of medical cost sharing in which the medical insurance institution and the patient jointly bear the costs.

The so-called personal out-of-pocket ratio refers to the proportion of medical expenses allowed to be paid by the medical insurance policy that is borne by the insured person.

1. What is the reimbursement ratio of Category B medical insurance?

The reimbursement ratio of Class B medical insurance is: 10% is paid first, and then reimbursed at 85% or 92%.

The reimbursement ratio of Category A and Category B of medical insurance varies from place to place.

Category B patients have to pay part of it themselves and reimburse part of it. The specific reimbursement ratio varies according to local policies and specific drugs.

The medical insurance list is selected based on the national essential medicine list, and Category A and B drugs are determined based on the efficacy-price ratio.

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.

2. For cholecystitis hospitalization medical insurance reimbursement ratio: medical expenses above 13,000 yuan to 100,000 yuan (inclusive), large medical insurance premiums are 94%, and individuals pay 6% out of pocket; medical expenses above 21,000 yuan to 200,000 yuan (inclusive)

For medical expenses, 96% of large-amount medical insurance premiums are paid and 4% is paid by individuals; for medical expenses above 32,000 yuan, 98% is paid by large-amount medical insurance premiums and 2% is paid by individuals.

In one year, the maximum proportional payment for large medical insurance premiums is 300,000 yuan per person.

3. How to use the money in employee medical insurance. The money in the medical insurance card is a personal account, not how much is paid to the bank. The fees paid for employee medical insurance are divided into personal accounts and overall accounts.

Personal accounts can be used for outpatient consumption or self-pay expenses. The collective account is used to reimburse large medical expenses such as hospitalization on a proportional basis according to regulations. Therefore, the medical insurance paid does not protect oneself, but the state protects the individual.

of medical care.

Taking Zhengzhou as an example, according to Article 22 of the "Zhengzhou City Basic Medical Insurance Measures for Employees", the employee medical insurance premiums paid by the employer and the insured individuals constitute the employee medical insurance fund. The employee medical insurance fund is divided into a pooled fund and individual accounts.

.

Article 25 The overall pool fund is mainly used to pay for inpatient medical expenses, outpatient medical expenses for prescribed diseases, and outpatient medical expenses for serious and serious diseases.

Personal accounts are mainly used to pay for general outpatient medical expenses, drug purchase expenses, and inpatient medical expenses that are borne by the individual. When the balance of the personal account is insufficient for payment, the excess will be borne by the individual.

The overall fund and individual accounts shall be accounted for separately and shall not be misappropriated from each other.

Legal basis: Article 17 of the "Regulations on the Supervision and Administration of the Use of Medical Security Funds" stipulates that insured persons shall present their medical security certificates to seek medical treatment and purchase medicines, and actively present them for inspection.

Insured persons have the right to require designated medical institutions to truthfully issue expense receipts and relevant information.

Insured persons should properly keep their medical insurance certificates to prevent others from using them under their false names.

If you need to entrust another person to purchase medicines on your behalf due to special reasons, the identity certificates of the entruster and the trustee should be provided.

Insured persons shall enjoy medical security benefits in accordance with regulations and shall not enjoy them repeatedly.

Insured persons have the right to request medical security agencies to provide medical security consulting services and make suggestions for improving the use of medical security funds.