The limit of medical insurance reimbursement is not the total amount of personal account payment. The medical insurance reimbursement limit refers to the maximum amount of medical expenses paid by the medical insurance fund for the insured in a natural year, and the total amount paid by the individual account refers to the total amount of medical expenses paid by the insured in the individual account.

First, the concept and provisions of medical insurance reimbursement limit

The reimbursement limit of medical insurance is the highest limit of medical expenses paid by the medical insurance fund for the insured in a natural year. This limit is determined by the medical insurance department according to the local economic situation, the income and expenditure of the medical insurance fund and the medical level.

Medical insurance reimbursement limits usually include outpatient medical expenses limits, inpatient medical expenses limits and large medical expenses subsidies. The medical insurance reimbursement limit may be different in different regions, depending on the local medical insurance policy.

Second, the concept and provisions of the total amount of personal account payment

The total amount of personal account payment refers to the total amount of medical expenses paid by the insured in the personal account. This total amount is accumulated by the actual cash and personal account funds paid by the insured in the process of outpatient medical treatment and drug purchase.

The total amount of personal account payment and medical insurance reimbursement limit are two different concepts. The total amount of personal account payment reflects the actual medical expenses incurred by the insured, and the medical insurance reimbursement limit is the maximum medical expenses paid by the medical insurance fund for the insured.

To sum up:

The limit of medical insurance reimbursement is not the total amount of personal account payment, they are two different concepts. The reimbursement limit of medical insurance is the maximum amount of medical expenses paid by the medical insurance fund for the insured in a natural year, and the total amount paid by the individual account is the total amount of medical expenses paid by the individual account of the insured. Therefore, the insured should pay attention to distinguish these two concepts when enjoying medical insurance benefits, so as to better understand their medical expenses reimbursement.

Legal basis:

Article 30 of the Social Insurance Law of People's Republic of China (PRC) stipulates that employees should participate in the basic medical insurance for employees, and both employers and employees should pay the basic medical insurance premium. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium. The law does not clearly stipulate the relationship between the medical insurance reimbursement limit and the total amount paid in individual accounts, but it clearly stipulates that employees should participate in basic medical insurance and pay the corresponding insurance premiums. At the same time, the law also authorizes all localities to formulate specific medical insurance policies according to the actual situation, including the limit of medical insurance reimbursement and the total amount of personal account payment.