Expenses outside the scope of medical insurance coordination are expenses that are not included in the scope of medical insurance reimbursement, mainly including items stipulated in the terms of the medical insurance negative list (such as costs related to beauty), Category B and C in the drug catalog, which are not included in the reimbursement ratio, etc.

Medical insurance pooling refers to the remaining portion of the medical insurance premiums paid by all employers in a certain pooling area for their employees after deducting them and transferring them to individual accounts.

The medical insurance overall fund belongs to all insured persons, is centrally managed by social insurance agencies, and is uniformly allocated and used. It is mainly used to pay for medical expenses, surgical expenses, nursing expenses, basic examination fees, etc. incurred by insured employees.

The medical insurance pooling fund shall be stored and used exclusively for special purposes, and shall not be misappropriated by any unit or individual.

The overall fund includes: the remainder after deducting the total payment of all insured units in the coordinated area and recording it into individual accounts; financial subsidies; social donations; bank interest; late payment fees; commercial critical illness insurance, etc.

The medical insurance pooling fund belongs to all insured persons and is stored and used exclusively for special purposes. No unit or individual may misappropriate it.

The overall fund is mainly used for medical expenses such as hospitalization of insured persons, emergency rescue in non-designated hospitals, off-site referral (hospital), off-site placement, and special disease outpatient services.

The functions of medical insurance: 1. It is conducive to improving labor productivity and promoting the development of production.

Medical insurance is the inevitable result of social progress and production development.

In turn, the establishment and improvement of the medical insurance system will further promote social progress and production development.

On the one hand, medical insurance relieves workers from worries and allows them to work with peace of mind, thereby improving labor productivity and promoting the development of production; on the other hand, it also ensures the physical and mental health of workers and the normal reproduction of the labor force.

2. Adjust income differences and reflect social fairness.

Medical insurance adjusts income differences by collecting medical insurance premiums and reimbursing medical insurance service fees. It is an important means for the government to redistribute income.

3. An important guarantee for maintaining social stability.

Medical insurance provides financial assistance to sick workers, helps eliminate social instability caused by illness, and is an important social mechanism for adjusting social relations and social conflicts.

4. An important means to promote social civilization and progress.

The social system of medical insurance and social mutual aid, by sharing the risk of disease costs among insured persons, embodies a new social relationship of "when one party is in trouble, all parties support", which is conducive to promoting social civilization and progress.

5. An important guarantee for advancing the reform of the economic system, especially the reform of state-owned enterprises.