Different industries have different technical terms, so it is necessary to understand these terms when it comes to a certain industry. What does medical insurance fund payment mean? What aspects are included?

What is the medical insurance fund?

The medical insurance fund refers to the special funds for basic medical insurance for employees raised by medical insurance agencies from units and individuals to ensure basic medical care for employees. The basic medical insurance fund includes two parts: social pooling fund and individual account, which are paid by employers and individual employees according to a certain proportion.

What does the medical insurance fund pay mean?

The expenditure of basic medical insurance fund refers to the medical insurance benefits paid by social pooling fund to employees and retirees who participate in basic medical insurance, the medical expenses paid by personal account fund to employees and retirees who participate in basic medical insurance, and other expenses. Including hospitalization expenses, outpatient and emergency medical expenses, personal account fund expenses and other expenses.

Medical insurance and fund use:

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.

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.