2. The composition of funds is different: pooling funds to achieve fund benefits comes from the medical insurance fees paid by various units to employees; Personal account funds mainly come from the expenses paid by the insured and part of the expenses paid by the unit.
3. The scope of reimbursement is different: medical insurance pays large expenses such as reimbursement of hospitalization expenses, special outpatient expenses, partial chemotherapy and dialysis treatment expenses; Personal account is used to buy medicine, outpatient expenses, and the part that needs to be borne by individuals after overall payment.
What does medical insurance payment co-ordinate mean?
When we use medical insurance reimbursement, we use the overall account to reimburse, which is called medical insurance overall payment. The medical insurance pooling account shall be managed in a unified way, and the fund shall be used for special purposes. Therefore, the pooling fund belongs to all insured persons, and no unit or individual may misappropriate it privately.
The medical insurance pooling fund refers to the part of the medical insurance expenses paid by the employer. Part of the medical insurance fee paid by the employer is transferred to the personal medical insurance account, and the rest and interest become the overall fund. When the insured employee falls ill, the medical expenses within the scope of medical insurance can be reimbursed by the overall fund. The establishment of medical insurance pooling fund reflects social equity and is also conducive to reducing the burden on enterprises.
What is the personal account of medical insurance?
An account with medical insurance as a whole is a medical insurance personal account, not everyone's. Generally, urban workers who are insured will have personal accounts, and the money in the personal accounts is the medical insurance expenses paid by individuals when they pay medical insurance. Employees who are insured on the job, if their insurance status is normal, will have money transferred to their personal accounts every month.
The money in a personal account can be used to buy medicines at designated pharmacies or hospitals, and it can also be used to pay for outpatient expenses or the personal part of hospitalization medical expenses. If you want to check the personal account balance of medical insurance, you can call the social security customer service hotline directly, or you can check it at the social security service center and designated pharmacies. You can see the account balance when you pay for medicine with medical insurance.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.