Overall payment of medical insurance refers to reimbursement, and overall payment refers to the use of funds in the overall account to pay the relevant medical expenses of the insured; Account payment, that is, using the insured's medical insurance card to swipe the card at the pharmacy or clinic. Used for the behavior that happens when buying medicine at ordinary times. In some areas, part of the real-time settlement is coordinated, and the insured person does not need to pay in advance. In some areas, the insured pays in advance and then reimburses.

The scope of medical insurance reimbursement is as follows:

1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents. The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) (75+ age 0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%. Self-funded drugs are not reimbursed, 80% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and medical expenses cannot be reimbursed according to regulations;

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (1 year cumulative value);

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account;

4, serious illness insurance reimbursement insured suffering from a serious illness, in the city's medical insurance designated medical institutions, in line with the provisions of the city's medical insurance personal responsibility, into the scope of payment of residents' serious illness insurance, 50% reimbursement by the serious illness insurance fund.

To sum up, the medical insurance pooling fund payment is the statement of medical insurance reimbursement, and the payment of users through medical insurance reimbursement is completed by the medical insurance pooling fund.

Legal basis:

Article 26 of People's Republic of China (PRC) Social Insurance Law

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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.