Medical insurance refers to social medical insurance. Social medical insurance is a social security system created by my country and society in accordance with certain relevant laws and regulations to provide basic medical service needs to employees within the scope of protection when they fall ill. Basically, the medical insurance fund is composed of The overall fund is composed of individual accounts. All the basic medical premiums paid by employees themselves are credited to their personal accounts; the basic medical premiums paid by the employer are divided into two categories, one part is allocated to the personal account, and the other part is used to create the overall fund.

Whether it is employee medical insurance or urban medical insurance, after patients receive medical treatment, they must take the policy documents to the hospital's medical insurance window for approval and seal, and then manually clear it from the billing window. Now, my country has put this process online through network technology. Online settlement can be straightforward. Medical insurance reimbursement will deduct the money immediately, and the money needed by the patient must first be noted on the bill.

However, in the medical expense documents you see, the words "self-pay" and "self-pay" are usually included, which may not be easy to understand. In that case, the words "self-pay" and "self-pay" in the medical expense documents represent

What's the meaning?

How to reimburse medical insurance.

What do "self-pay" and "self-pay" in the medical income and expenditure details mean?

Out-of-pocket expenses refer to the medical expenses incurred by the insured during diagnosis and treatment or drug purchase, which are not covered by the medical insurance fund or exceed the reimbursement limit of the medical insurance, and should be borne by the beneficiary.

Mainly refers to the medical expenses incurred for Class C drugs, some diagnosis and treatment items, and special medical supplies outside the scope of the national medical insurance catalog. Generally, it can be summarized as self-paid drugs, self-paid items, and self-paid services. Self-paid expenses refer to the insured person’s medical insurance

Within the scope of fund payment or in accordance with the limits of medical insurance, after being settled by various medical insurance funds according to the prescribed amount or proportion, expenses shall be paid according to regulations. In addition to self-paid expenses, in medical expense documents, self-paid expenses are generally divided into self-paid expenses and self-paid expenses.

item.

Self-payment 1: A person's proportional share of expenses within the scope of medical insurance payment, including the part below the minimum payment standard and above the top line. Self-payment 2: refers to self-payment of drugs, tests, treatments and other expenses within the scope of medical insurance.

Material supply, part of which must be borne by the person in advance.

For example, for Class B drugs within the scope of the national medical insurance catalog, the individual must generally bear a certain proportion of the cost first, and the remaining amount will be reimbursed by the medical insurance in proportion. Among them, the first part of the cost borne by the individual will be self-pay1, and the medical insurance will prorate the cost.

The remaining amount after reimbursement of allocated expenses is self-pay2. In short, self-pay costs are expenses that are not reimbursed by medical insurance, and self-pay means that you bear the expenses proportionally within the scope of cooperative medical reimbursement.

How is medical insurance reimbursed?

Medical insurance reimbursement mainly includes three parts: the minimum payment standard, the limit line and the medical insurance reimbursement ratio. These three parts determine how much your medical insurance can reimburse you. Whether it is a hospital outpatient or inpatient treatment, there is a payment line. Generally, it starts from

From tens of thousands to several thousand yuan, once the medical expenses cannot exceed the starting point, the medical insurance will not reimburse the expenses. In addition to the starting point, there is also a cooperative medical reimbursement upper limit.

In other words, not all medical insurance expenses beyond the starting point are reimbursed, and those exceeding the top line are not reported. The expenses between the starting point and the cap line are the true expense reimbursement scope of medical insurance. However, this expense

Expense reimbursements are also prorated, detailing out-of-pocket expenses above the client's program.

The reimbursement ratio of medical insurance is mainly related to the age of the insured, the designated medical institution and whether he is retired. The repayment ratio varies according to different situations. Generally speaking, the older the patient, the greater the reimbursement amount, and the medical institution to which the patient belongs

The higher the level, the smaller the reimbursement rate. Although medical insurance can reimburse our own medical expenses, it cannot guarantee our entire life. Therefore, we must create our own commercial services to supplement medical care.