1. Coverage: The overall payment of medical insurance is applicable to the insured who participate in various medical insurance systems such as basic medical insurance for urban workers, basic medical insurance for urban and rural residents, and new rural cooperative medical care.
2. Scope of medical expenses: the scope of medical insurance payment includes medical items, medicines and medical materials in the basic medical insurance catalogue, and may also include some special medical services according to the specific provisions of different medical insurance systems.
3. Proportion of medical insurance payment: The overall proportion of medical insurance payment varies according to the provisions of different medical insurance systems. Generally speaking, the medical insurance foundation pays a certain proportion of medical expenses, while individuals need to pay part of their own expenses. The specific proportion shall be formulated by the local medical insurance departments.
4. Medical insurance payment limit: There is also a payment limit for overall medical insurance payment, that is, the medical insurance fund has a certain upper limit for the payment of some high-priced medical items or high expenses, and the part that exceeds the limit needs to be borne by individuals themselves.
5. Payment method of medical insurance: The overall payment of medical insurance can be settled through medical insurance card and electronic certificate. Individuals only need to show relevant medical insurance certificates when seeking medical treatment, and no cash payment is required.
Attention should be paid to the use of medical insurance cards:
1. Cash withdrawal is prohibited.
No unit or individual may violate the scope and requirements of the medical insurance card, and it is strictly forbidden to take cash.
2. Some provincial and municipal medical insurance cards can be used by the whole family.
In some provinces and cities, such as Zhejiang Province and Guangzhou City, the surplus funds of individual medical insurance accounts over the years can be used to pay the medical insurance expenses of employees' spouses, children, parents and other close relatives who participate in basic medical insurance, so as to realize mutual assistance among family members.
3. The following medical insurance will not be paid.
Seeing a doctor in a non-designated medical institution or buying medicine in a non-designated retail pharmacy (except emergency): self-injury caused by personal fighting, drug abuse or other illegal acts; Treatment for alcoholism, suicide and self-mutilation; Injuries caused by traffic accidents, medical accidents or other liability accidents; And the situation that the state or local regulations should be paid by individuals.
To sum up, the overall payment of medical insurance refers to a way in which medical expenses are paid by the medical insurance fund under the medical insurance system. Applying for medical insurance payment needs to meet certain procedures and conditions.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 12
The basic medical insurance premium is levied on a monthly basis, and the employer and employees shall pay the basic medical insurance premium to the tax collection authority within the prescribed time limit. The part that individual employees should pay shall be withheld and remitted by the employer from their wages.