Hello, the part paid by the company is a co-ordination account, and the individual pays a personal account. The co-ordination account is used during hospitalization, and the personal account can be used for daily pharmacy purchases and outpatient services.

source of funds for the pooling fund:

the pooling fund for basic medical insurance is the basic medical insurance premium paid by the employer, and the remaining funds and interest income after deducting the part transferred to the personal account are the pooling fund for basic medical insurance.

purpose of pooling fund:

pooling fund is mainly used to pay the expenses of outpatient and inpatient medical expenses for special diseases, which fall within the scope of basic medical insurance payment. It can't pay the expenses of general outpatient expenses and all self-funded items, and can't pay the medical expenses caused by illegal crimes, alcoholism, suicide, self-mutilation, work injury, maternity, traffic accidents, medical accidents and other liability accidents.

1. Personal account, the money reflected in the medical insurance card, can be used to buy medicines at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses paid by individuals; 2, the overall account, managed by the medical insurance center, the insured in line with the local medical insurance reimbursement expenses paid by the overall account.

(1) The medical expenses of employees and retirees who meet the requirements for outpatient treatment of severe diseases shall be paid by the pooling fund according to the following proportions, but individuals shall also bear a certain proportion:

1. Employees shall be paid by the pooling fund for medical treatment, 8% by the individual, and 2% by the individual

2. Retirees shall be paid by the pooling fund, and 15% by the individual.

(2) when the medical expenses of employees and retirees for hospitalization, outpatient emergency rescue or outpatient treatment of some serious diseases in an insurance year exceed the "cap line" of the overall fund, the commercial insurance company will be responsible for the claims according to the method of subsection calculation and cumulative payment, but individuals will also bear a certain proportion of the expenses, specifically:

1. For medical expenses ranging from 3, yuan to 1, yuan (inclusive), 94% of the large medical insurance premium is paid, and 6% is paid by the individual;

2. For medical expenses ranging from 1, yuan to 2, yuan (inclusive), 96% of the large medical insurance premium is paid, and 4% is paid by the individual;

98% of the medical expenses above RMB 3, and RMB 2, are paid by large medical insurance premiums, and 2% is paid by individuals themselves. In a year, the maximum proportional payment for large medical insurance premiums is 3, yuan per person. In addition, in an insurance year, if the medical expenses paid by individuals within 3, yuan (excluding the medical expenses of Qifubiaozhun and the medical expenses that do not meet the requirements of basic medical insurance) exceed 4, yuan, the commercial insurance company will give 1 yuan a one-time subsidy.

Legal basis

Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with state regulations.