The part paid by the medical insurance pooling fund refers to the part paid by the medical insurance pooling fund in the medical expenses under the medical insurance system. When the insured goes to a designated medical institution for medical treatment and generates medical expenses, the medical insurance pooling fund will pay the medical expenses that meet the requirements of the medical insurance policy in accordance with the prescribed proportion and standard.

First, the concept of medical insurance pooling fund

The medical insurance pooling fund is an important part of the medical insurance system, which is jointly raised by the government, enterprises and individuals. Its purpose is to share the financial burden of the insured in medical expenses and ensure the basic medical needs of the insured.

Second, the scope of medical insurance fund payment

The scope of medical insurance fund payment mainly includes outpatient service, hospitalization, special diseases and other medical expenses that meet the requirements of medical insurance policy. The specific payment ratio and standard vary according to the different medical insurance policies.

Three, the medical insurance fund payment method

Payment of medical insurance funds is usually made through designated medical institutions. Insured persons need to carry valid certificates such as medical insurance cards when seeking medical treatment, so that medical institutions can settle the part that should be paid by the medical insurance pooling fund in real time.

Fourth, the role of the medical insurance pooling fund.

The existence of medical insurance pooling fund payment has effectively reduced the economic pressure of the insured and enabled more people to enjoy quality medical services. At the same time, it also promotes the rational utilization of medical resources and improves the efficiency and quality of medical services.

To sum up:

Medical insurance pooling fund payment is one of the core contents of medical insurance system. Raise funds through various channels, share the burden of medical expenses of the insured, and ensure the basic medical needs. Wide payment range and convenient payment method are of great significance for improving the level of medical services and promoting the rational use of medical resources.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 23 provides that:

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

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 scope of payment of the basic medical insurance fund: (1) those that should 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. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.