Overall payment of medical insurance is reimbursement. If the related medical expenses paid by the insured are within the standard range of medical treatment items and medical service facilities, they can apply for reimbursement, that is, the medical insurance pooling fund will settle the payment for the insured.

Medical insurance pooling fund payment refers to medical insurance reimbursement, and there are two reimbursement methods for medical insurance reimbursement.

One is that after being hospitalized in the hospital, when going through the discharge formalities, you can directly handle the medical insurance settlement at the medical insurance window of the hospital. In this case, it can be reimbursed on the spot. After reimbursement, the hospitalization expenses paid in advance by users are refunded more and supplemented less. Second, prepare the hospitalization expenses list, hospitalization certificate, discharge summary and other materials to the local medical insurance bureau for reimbursement procedures. After the reimbursement is successful, the Medical Insurance Bureau will transfer the reimbursed medical expenses to the user's bank card account.

It should be mentioned that in the case of direct reimbursement of medical insurance, if it is a medical treatment in a different place, it is necessary to go to the local medical insurance bureau in advance to go through the relevant filing procedures for medical treatment in a different place, otherwise it will affect the on-site reimbursement. In addition, if you are reimbursed directly in the hospital, you need to prepare social security cards and other materials in addition to medical insurance cards before you can apply for reimbursement.

In short, the payment of the medical insurance pooling fund is the statement of medical insurance reimbursement, and the payment of users through medical insurance reimbursement is completed by the medical insurance pooling fund.

legal ground

Article 26 of People's Republic of China (PRC) Social Insurance Law

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

People's Republic of China (PRC) social insurance law

Article 29

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.