Differences in overall payment standards:
1, the basic medical expenses incurred by the insured during the designated outpatient time due to emergency treatment 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, as a whole 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 referral to the community health service center, the overall fund in accordance with the provisions of payment; 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.
Extended data:
Medical insurance belongs to the business scope of labor security. The basic medical insurance premiums paid by the insured individuals are all included in the personal account; The basic medical insurance premium paid by the insured unit, except for the part credited to the personal account, is all used as a unified fund, which is managed and used uniformly by the medical insurance agency.
Personal accounts are mainly used to pay for outpatient and drug purchase expenses, and the overall fund is mainly used to pay for medical expenses of insured persons for hospitalization, outpatient specific projects and some chronic diseases and family beds. The serious illness medical assistance fund is used to pay the hospitalization medical expenses above the maximum payment limit of the basic medical insurance pooling fund of the insured.
At present, the financing mode of the basic medical insurance system for urban workers in China is the combination of social pooling and individual accounts, that is, employers and employees pay basic medical insurance premiums according to a certain proportion of total wages, forming social medical pooling funds and individual medical account funds.
References:
Medical Insurance Fund-Baidu Encyclopedia