I. Payment of hospitalization expenses
When the insured person needs hospitalization due to illness, the medical insurance pooling account will pay a certain proportion of hospitalization expenses according to the policy. This includes bed fee, nursing fee, operation fee, treatment fee, examination fee, etc. The specific payment ratio and limit will vary according to different medical insurance policies.
Second, the payment of outpatient fees.
The medical insurance account can not only pay the hospitalization expenses, but also pay the outpatient expenses incurred by the insured in the designated medical institutions. This includes registration fee, medical treatment fee, examination fee, medicine fee, etc. Similarly, the specific payment ratio and limit will vary according to the different medical insurance policies.
Three. Payment of medicine fee
Insured people can buy drugs that meet the medical insurance catalogue at designated pharmacies, or they can use the funds in the medical insurance co-ordination account to pay. Drugs in the medical insurance catalogue are generally reimbursed in a certain proportion, and the specific proportion will vary according to the types of drugs and medical insurance policies.
Fourth, matters needing attention
It should be noted that the funds in the medical insurance pooling account are not unlimited, but have a certain payment limit. When the medical expenses of the insured exceed this limit, they need to bear the extra expenses themselves. In addition, different medical insurance policies will have different payment ratios, limits and reimbursement ranges, so insured people need to understand and abide by relevant policies and regulations when using the funds in the medical insurance pooling account.
To sum up:
The money in the overall medical insurance account is mainly used to pay the medical expenses incurred by the insured in designated medical institutions and pharmacies, including hospitalization expenses, outpatient expenses and drug expenses. Insured persons need to understand and abide by the relevant policies and regulations when using the funds in the medical insurance pooling account to ensure that their rights and interests are protected.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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.
People's Republic of China (PRC) social insurance law
Article 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.