When a unit or individual pays medical insurance every month, the basic medical insurance premium paid by the individual shall be included in the personal account. The amount included in the personal account is the amount allocated by the medical insurance account, and the funds in the medical insurance personal account are owned by the individual. The funds in the account can only be used for personal medical expenses, which is a special account; Account funds belong to individuals, and the system allows carry-over and family inheritance.
The reimbursement scope of medical insurance mainly includes the following contents:
1, which meets the requirements of general outpatient consultation fees, expert outpatient consultation fees and emergency consultation fees of medical institutions;
2, designated medical institutions general ward bed fee;
3, outpatient decocting fee;
4, designated medical institutions for medical treatment, dispensing or retail pharmacies dispensing medical expenses;
5, in line with the basic medical insurance treatment project, medical service facilities, medication scope and payment standard of medical expenses.
To sum up, the setting of medical insurance limit is to control the expenditure of medical insurance fund and ensure the sustainability of medical insurance fund. Therefore, when enjoying medical insurance benefits, we should make rational use of medical resources to avoid unnecessary medical expenses and expenses exceeding the limit.
Legal basis:
Article 10 of People's Republic of China (PRC) Social Insurance Law
Employees shall participate in the basic old-age insurance, and the employer and employees shall jointly pay the basic old-age insurance premium.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employer and other flexible employees can participate in the basic old-age insurance, and individuals pay the basic old-age insurance premium.
The measures for the endowment insurance of civil servants and staff managed by reference to the Civil Service Law shall be formulated by the State Council.
Article 28
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.
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.