Overall fund refers to the payment that is not recorded in the account and needs to enter the overall fund. Co-ordination fund means that all units pay part of the fees in a unified fund, and then pay the funds from this unified fund to the insured who need to enjoy the treatment.
All insurance funds are managed separately, that is, each insurance has its own overall fund.
The medical insurance pooling fund refers to the remaining part of the medical insurance premiums paid by all employers for employees in the overall planning area after deducting personal accounts.
The medical insurance pooling fund belongs to the insured, which is stored in a special account and earmarked, and no unit or individual may misappropriate it. The overall fund is mainly used for medical expenses such as hospitalization of insured persons, emergency rescue in non-designated hospitals, referral from different places (hospitals), resettlement in different places, and special disease clinics.
The difference between the payment standards of pooling funds:
(1) The basic medical expenses incurred by the insured person during the designated outpatient time due to emergency directly to the town (street) community health service center shall be paid by the overall fund according to the regulations.
(2) the insured person directly to the town (street) community health service center outpatient rescue of basic medical expenses, the overall fund to pay in accordance with the provisions; The proportion of basic medical expenses incurred by direct visits to designated outpatient clinics and outpatient rescue in medical institutions outside the town (street) community health service center will be reduced by 10%.
(3) The designated outpatient service is referred to the community health service center, and the overall fund is paid as required; Transferred to the outpatient department of the town (street) designated hospital headquarters or the outpatient department of the municipal designated specialized hospital headquarters, the proportion of overall fund payment decreased by10%; Transfer to the outpatient department of the designated tertiary hospital in the city, and the payment ratio will be reduced by 20%; Transferred to other medical institutions, the overall fund will not be paid.
(4) In addition to the above situation, the insured person goes to a medical institution other than the designated outpatient clinic for medical treatment, and the overall fund will not pay.