Simply put, the medical insurance pooling fund is not the money of the medical insurance card, but the account used to settle the hospitalization reimbursement.
In addition, when the actual medical insurance is reimbursed, there will be restrictions such as deductible line, capping line and reimbursement ratio, and not all expenses can be reimbursed by medical insurance.
What should I do if the medical insurance pooling account is frozen?
The medical insurance card is frozen, generally because it is not paid on time, so you only need to pay the unpaid fees. The insured can contact the employer to understand the payment situation and pay the medical insurance premium to the tax department of the unit as soon as possible.
If you confirm that medical insurance has not interrupted payment, you can go to the residents' medical insurance service station or medical insurance center to inquire about the specific situation.
As for the medical treatment during the overall freezing of medical insurance benefits, you can advance the medical expenses yourself first. After the medical insurance benefits return to normal, you can submit the invoices, original lists, original medical records and copies (including outpatient medical records and discharge summaries) and other related materials to the medical insurance center for manual reimbursement.
If the payment is frozen due to the interruption, if the interruption does not exceed 3 months, the medical expenses incurred during the period can enjoy the medical insurance benefits.
In addition, during the overall freeze of medical insurance benefits, the balance of medical insurance personal account can still be used to pay for going to the hospital.
What does the medical insurance pooling account mean?
Medical insurance co-ordination account refers to the medical insurance co-ordination area after deducting the medical insurance premium paid by the employer for the employees, and the rest is included in the personal account. This part of the money is used to propose a medical insurance pooling fund, which belongs to all insured persons and is managed centrally by social insurance agencies. It is mainly used to pay the medical expenses incurred by insured workers in medical insurance coverage.
The overall medical insurance fund shall be earmarked, and no unit or individual may misappropriate it.
Legal basis:
Article 30 of the Basic Medical and Health Promotion Law of People's Republic of China (PRC) promotes the graded diagnosis and treatment system of basic medical services, guides non-emergency patients to go to primary medical and health institutions first, implements the responsibility system of first diagnosis and referral review, and gradually establishes the mechanism of first diagnosis, two-way referral, fast and slow division of labor and linkage up and down, which is connected with the basic medical insurance system. The local people's governments at or above the county level shall, according to the medical and health needs of their respective administrative areas, integrate the medical and health resources organized by the local government, and establish cooperative medical service cooperation mechanisms such as medical consortia according to local conditions. Encourage medical and health institutions organized by social forces to participate in the medical service cooperation mechanism.