When your personal medical insurance account is used up, you can use the pooled account.

When the money in the personal account of the medical insurance card is used up, it must be borne by the individual.

After the individual's total self-pay exceeds the prescribed amount, if the excess medical expenses exceed the prescribed amount, the individual will bear the excess medical expenses in different proportions according to the type of hospital, and the rest will be paid by the overall fund.

The method for coordinating account reimbursement is as follows: 1. When purchasing medicines, the cardholder goes to a designated medical insurance institution to buy medicines, and the expenses go to a personal account; medical insurance is divided into two accounts, the personal account, and the money reflected in the medical insurance card can be used

When buying medicines at designated pharmacies, outpatient expenses and out-of-pocket portion of hospitalization expenses are paid; the overall account is managed by the medical insurance center, and the expenses incurred by the insured that are eligible for local medical insurance reimbursement are paid from the overall account; 2. Go to the outpatient clinic for medical treatment,

Keep the original documents such as diagnosis certificates, medical records, report forms, payment receipts, etc., and go to the local social security agency for reimbursement; when seeking medical treatment, show your medical insurance card to the designated hospital to prove your insured status. When checking out, the individual will pay the out-of-pocket portion.

You pay by yourself with your medical insurance card or cash. The reimbursement part of the medical insurance will be settled by the medical insurance and the hospital. Individuals do not need to pay first and then reimburse; 3. When you are hospitalized, you must deposit a certain deposit first, and the payment will be settled according to the medical insurance reimbursement ratio when you are discharged.

Reimbursement for any refund; when reimbursing for hospitalization, there is a deductible, which means that the deductible must be paid by yourself. The portion exceeding the deductible can be reimbursed according to local medical insurance regulations. The reimbursement ratio varies from place to place, probably

About 75%.

Medical insurance overall reimbursement ratio: 1. Medical expenses incurred in tertiary hospitals: (1) For the part from the minimum payment standard to 30,000 yuan, the overall fund will pay 85% and the employee will pay 15%; (2) For the part exceeding 30,000 yuan to 40,000 yuan

For the portion exceeding RMB 40,000, the overall fund will pay 90% and the employees will pay 10%; (3) For the portion exceeding RMB 40,000, the overall fund will pay 95% and the employees will pay 5%.

2. Medical expenses incurred in secondary hospitals: (1) For the part from the minimum payment standard to 30,000 yuan, the overall fund will pay 87%, and the employees will pay 13%; (2) For the part exceeding 30,000 yuan to 40,000 yuan, the overall fund will pay 87%.

The fund pays 92% and employees pay 8%; (3) For the part exceeding 40,000 yuan, the overall fund pays 97% and employees pay 3%.

3. Medical expenses incurred in first-level hospitals and family beds: (1) For the part from the minimum payment standard to 30,000 yuan, the overall fund will pay 90% and the employee will pay 10%; (2) For the amount exceeding 30,000 yuan to 40,000 yuan

For part, the overall fund pays 95% and employees pay 5%; (3) For the part exceeding 40,000 yuan, the overall fund pays 97% and employees pay 3%.

4. The personal payment ratio of retirees is 60% of the employee payment ratio.

To sum up, the maximum proportional amount paid by the basic medical insurance pooling fund shall not exceed approximately 4 times the average salary of employees in this city in the previous year.

Legal basis: Article 29 of the "Social Insurance Law of the People's Republic of China" The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit

.

The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.

Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.