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Co-ordination fund refers to the payment that is not recorded in the account and needs to enter the co-ordination fund. Co-ordination fund is to put the contributions of all units into a public fund, and then pay this fund from this unified co-ordination fund to the insured who need to enjoy the treatment.
Overall fund generally refers to the separate management of the overall fund of various insurance funds, that is, each insurance type has its own overall fund.
All insurance funds are managed separately, that is, each insurance has its own overall fund.
It is an important principle that the basic medical insurance combines social pooling with individual accounts.
There are four specific provisions for the establishment and use of pooling funds and individual accounts:
The first is to establish overall funds and personal accounts. Personal contributions are all included in personal accounts; About 30% of the unit payment is included in the personal account, and the rest is set up as a whole. The principal and interest of an individual account are owned by the individual and can be carried forward and inherited. Second, pooling funds and individual accounts should define their respective payment ranges and manage them separately. Personal accounts are mainly used for minor illness or outpatient expenses, and pooling funds are mainly used for serious illness or hospitalization expenses. The purpose is to clarify their respective responsibilities, avoid pooling funds to overdraw personal accounts, and facilitate management.
The third is to formulate the minimum payment standard and maximum payment limit of the overall fund. Qifubiaozhun is controlled in principle at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled in principle at about 4 times of the average annual salary of local employees.
Medical expenses below Qifubiaozhun shall be paid by personal account or borne by individuals. Medical expenses above Qifubiaozhun and below the maximum payment limit are mainly paid from the overall fund, and individuals also have to bear a certain proportion.
Medical expenses exceeding the maximum payment limit can be solved through supplementary medical insurance. The specific Qifubiaozhun and the maximum payment limit of the overall fund, as well as the personal burden ratio of medical expenses above Qifubiaozhun and below the maximum payment limit, shall be determined by the overall planning area according to the principle of balance of payments.
Fourth, in a few areas where the proportion of contributions is low and it is difficult to transfer part of the funds into personal accounts, people can be temporarily excluded and used to establish overall funds first.