The portion paid by the medical insurance unit goes to the pooling account.
The basic medical insurance fund consists of a pooled fund and individual accounts.
All basic medical insurance premiums paid by individual employees are credited to their personal accounts.
The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish the overall fund, and the other part is transferred to the personal account.
The proportion transferred to the personal account is generally about 30% of the employer's payment. The specific proportion is determined by the coordinating region based on factors such as the payment scope of the personal account and the age of the employee.
Medical insurance reimbursement process: 1. Under normal circumstances, when you need to be hospitalized for illness, take your medical insurance card and medical records to your designated hospital, and you can use your medical insurance card to settle the bill.
That is to say, you pay the self-pay part yourself, and the reimbursement part is settled by the medical insurance center and the hospital; 2. If you are transferred from your own designated hospital to a secondary or tertiary hospital, you will use your medical insurance card to settle the bill; 3. Your condition is critical and you are hospitalized in a hospital other than your own designated hospital.
For emergency treatment, go to the Municipal Medical Insurance Center within 5 days to apply for emergency rescue disease identification. After it is determined that the emergency rescue disease belongs to the emergency rescue disease, you can use the medical insurance card to settle the bill at the emergency hospital; 4. For transfer to other places for treatment, the transfer must be approved by the hospital and the medical insurance center.
formalities.
Expenses incurred in other places will be settled at the individual's own expense first. After diagnosis and treatment, complete information will be prepared and reimbursed through the community labor and security workstation; 5. Medical insurance reimbursement is calculated on a proportional basis, generally ranging from 70%.
The proportion and amount of reimbursement are related to factors such as your own examination and medication, medical level, etc.; 6. When reimbursing, the insured needs to prepare relevant information for hospitalization, such as outpatient medical records, discharge records, and discharge diagnosis certificates.
(Disease diagnosis certificate), hospitalization invoice (outpatient invoice can be provided if you can apply for outpatient service), total list of hospitalization expenses, medical insurance settlement form, if you have been hospitalized for CT, ultrasound, electrocardiogram and other examinations, provide relevant examination reports; 7. Discharge settlement, related
After submitting the information, reimbursement can be made at the medical insurance reimbursement window. After the review is passed, the reimbursed amount will usually arrive in your account in about 15 working days.
To sum up, the part paid by the company is a general account, and the part paid by the individual is a personal account. The general account is used when hospitalized, and the personal account can be used for daily drug purchases in pharmacies and outpatient services.
Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" that meets the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be deducted from the basic medical insurance fund in accordance with national regulations.
Pay.
Article 29 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.