1. Proportion of overall fund payment: The overall medical insurance fund is paid by both the government and the insured to pay the medical expenses in medical insurance coverage. The specific proportion of overall fund payment may vary according to regions and medical insurance policies, generally between 70% and 90%;

2. Proportion of individual contributions: When the insured enjoys medical insurance benefits, they need to pay medical expenses according to a certain proportion. The specific individual payment ratio may vary according to different regions and medical insurance policies, generally between 10%-30%. It should be noted that for some special medical items, such as critical illness medical insurance and outpatient chronic disease medical insurance, the proportion of individual payment may be different.

The provisions of the medical insurance account include the following aspects:

1. Payment method: medical insurance participants are required to pay medical insurance expenses in full and on time, and the medical insurance expenses will be included in the overall medical insurance account.

2. Scope of use: medical insurance participants can use the funds in the medical insurance pooling account to reimburse the medical expenses specified in the medical insurance catalogue.

3. Reimbursement ratio: The funds in the overall medical insurance account can be reimbursed according to the reimbursement ratio specified in the medical insurance catalogue.

4. Reimbursement limit: the maximum amount of medical insurance reimbursement that medical insurance participants can enjoy within the specified time.

5. Account management: Social insurance agencies are mainly responsible for the overall management of medical insurance accounts, and the use of overall accounts and the flow of funds need to be accounted for and managed in detail.

To sum up, the medical insurance policies in different regions will be different, and the specific medical insurance pooling account provisions shall be subject to the local policies and regulations. If you need to know the specific rules and procedures of medical insurance pooling account, it is recommended that you consult the local social insurance bureau or relevant departments.

Legal basis:

Article 28 of the Regulations of People's Republic of China (PRC) Municipality on the Basic Medical Insurance for Urban Employees.

Personal accounts are used to pay medical expenses beyond the scope of the overall fund payment; If the personal account is insufficient to pay, it shall be borne by me.

Article 29

The hospitalization expenses for major diseases are paid in the following ways:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.

The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.

Article 30

Medical expenses below Qifubiaozhun and above the maximum payment limit will not be paid by the overall fund.