Definition:
The medical insurance pooling fund refers to the medical insurance premiums paid by all employers for employees in an overall planning area. The medical insurance pooling fund belongs to all the insured persons, and is centrally managed and uniformly used by social insurance agencies. Mainly used to pay medical expenses, operation expenses, nursing expenses, basic examination fees, etc. List of insured employees. The medical insurance fund shall be stored in a special account for special purposes, and no unit or individual may misappropriate it.
Use:
The overall fund is mainly used to pay for outpatient and inpatient medical expenses for special diseases in medical insurance coverage. We can't pay the general outpatient expenses and all self-funded items, and we can't pay the medical expenses caused by illegal crimes, alcoholism, suicide, self-mutilation, work-related injuries, maternity, traffic accidents, medical accidents and other liability accidents.
Usage rules:
The medical insurance fund belongs to all insured persons, and it is stored in special accounts and earmarked for special purposes, and no unit or individual may misappropriate it. The overall fund is mainly used for medical expenses such as hospitalization of insured persons, emergency rescue in non-designated hospitals, referral from different places (hospitals), resettlement in different places, and special disease clinics.
: Baidu Encyclopedia-Medical Insurance Co-ordination Fund
Baidu Encyclopedia-Personal Account of Medical Insurance
Medical insurance includes medical insurance pooling fund and individual account.
The full name of medical insurance personal account is called personal medical insurance personal account, which is referred to as personal account for short. Personal accounts are mainly used to record and store personal account funds and are used for personal medical consumption according to regulations. The main sources of personal account funds include: medical insurance premiums paid by individuals; A certain percentage of social medical insurance premium paid by the employer; Some include personal account start-up funds paid by employers for individuals; There is also the interest income of personal account funds generated with the increase of insurance years.
Personal account payment scope: usually used to pay the insured's specific medical expenses, including outpatient expenses incurred by designated medical institutions; Drug purchase expenditure of designated retail pharmacies; In the basic medical expenses for specific items of hospitalization and outpatient service in designated hospitals, the expenses below the Qifubiaozhun of the overall fund shall be paid; Exceeding the minimum threshold, the expenses that should be borne by individuals. The insured person's use of personal account funds to pay medical expenses shall conform to the provisions of the scope of basic medical drugs, the scope of diagnosis and treatment projects, the scope of medical service facilities and payment standards.
According to overall management, the basic medical insurance for urban workers in China is divided into two accounts, namely, overall account and individual account. The personal account here is the medical insurance personal account.