Part of residents' individual medical insurance contributions and state subsidies are all included in the overall fund for diagnosis and treatment, and its core purposes are as follows.
First, the insured inpatient outpatient rescue costs. For example, if the insured person dials 120 due to sudden illness and goes to a designated hospital for rescue, and is transferred after the rescue, the hospital outpatient rescue expenses should be included in the medical insurance fund reimbursement category when the medical expenses are settled.
The second is the outpatient expenses for special outpatient diseases. Special outpatient diseases mainly refer to patients with hypertension, diabetes, diabetes or major diseases. Because of the need for long-term outpatient treatment or medication, radiotherapy and chemotherapy or analysis, if these patients apply for outpatient special diseases or chronic diseases, they can enjoy salary reimbursement for outpatient special diseases and chronic diseases.
The third is reimbursement of hospitalization expenses. Hospitalization expenses are an important reimbursement method for residents' medical insurance. Employees who are insured by medical insurance for urban and rural residents will be reimbursed for hospitalization expenses after hospitalization. The scope of reimbursement includes medical expenses and drug expenses above the deductible line and within the maximum reimbursement amount covered by the national medical insurance catalogue, and the reimbursement ratio is determined according to the hospital level. The reimbursement rate of township hospitals and community health services can reach more than 85%, and the reimbursement rate of referral outside tertiary hospitals and overall planning areas is at least 40% to 50%.
Generally speaking, the payment of residents' medical insurance, whether it is part of state subsidies or part of individual contributions, is classified as the overall fund for diagnosis and treatment, and will not be classified as a personal account, so residents' medical insurance does not have a personal account. People who participate in residents' medical insurance can only enjoy salary reimbursement when they are hospitalized, applied for special outpatient diseases, and rescued in hospital outpatient service. General outpatient expenses cannot be reimbursed by medical insurance.
Residents' medical insurance is a combination of the former rural new rural cooperative medical system and urban and rural residents' medical insurance. Whether it is the previous new rural cooperative medical system or the urban residents' medical commercial insurance, the current urban and rural residents' medical commercial insurance is mainly aimed at creating a diagnosis and treatment co-ordination fund, and no personal account is created.
Because urban medical insurance is a state subsidy, the form of individual payment and the payment standard are very low. At the beginning, the annual payment was only 10 yuan, and even today, it is only 320 yuan. If this 320 yuan is included as a part of personal account, it will not only reduce the medical income of the overall fund, but also endanger the stock fund for reimbursement of hospitalization expenses. At the same time, the personal account assets of several tens of yuan a year cannot solve the problem of residents seeking medical treatment.
In view of the areas where residents' personal medical insurance accounts or personal accounts at home were established in some areas in the past, the National Medical Insurance Bureau later introduced the criteria for cancellation. Therefore, the current urban medical insurance only has an overall fund account, and there is no personal account.
The construction of personal accounts mainly refers to the medical insurance for employees. Employee medical insurance often establishes personal accounts. The fundamental reason is that the payment standard of employee medical insurance is very high. Probably pay at least 3000 yuan to 5000 yuan a year. As an on-the-job employee, in addition to corporate contributions, employees themselves need to pay at a rate of 2%. In order to solve the problem of outpatient expenses for employees, employee medical insurance has established a personal account.
Personal account is usually 2% of the employee's own contributions. According to the average age of employees, part of the contributions paid by enterprises need to be returned to the employee's personal account. However, in the future, part of the expenses paid by employees' medical insurance enterprises will not be refunded to employees' personal accounts, but an outpatient medical insurance system will be established to deal with the reimbursement of outpatient expenses.