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Some questions about overall fund payment in medical insurance

The medical insurance co-ordination fund refers to the remaining portion of the medical insurance premiums paid by all employers in a certain co-ordination area for their employees, after deducting and transferring them to individual accounts.

The overall fund payment is to use the funds from the overall account to pay the relevant medical expenses of the insured, and the account payment is to use your medical insurance card to swipe the card for consumption in pharmacies or outpatient clinics.

Personal payments are not reimbursable.

Extended information: The medical insurance card is divided into two accounts, one is a personal account and the other is a collective account.

The personal account is reflected in the monthly payment of medical insurance, and part of it will be returned to the medical insurance card, which is the balance in the medical insurance card. The insured can use it to buy medicines at designated pharmacies, pay for outpatient expenses and the personal out-of-pocket portion of hospitalization expenses;

The overall fund refers to the fund part in which all units' medical insurance payments are unified into a public fund, and is a part of the payment that is not credited to individual accounts.

The overall fund payment refers to using the funds from the overall account to pay the relevant medical expenses of the insured. The use of the overall fund payment must comply with the local medical insurance policy, including the hospital, medical institution, reimbursement range, deductible and proportion of the overall fund payment standards.

Differences: ① The basic medical expenses incurred by the insured person directly to the town (street) community health service center for emergency treatment outside the service hours of the designated outpatient medical point will be paid by the overall fund in accordance with regulations.

② The insured person directly goes to the community health service center of the town (street) for outpatient rescue and the basic medical expenses incurred by the overall fund shall be paid according to regulations; the insured person directly goes to the designated outpatient medical treatment point and the city's medical treatment other than the community health service center of the town (street)

The proportion of basic medical expenses incurred by the institution’s outpatient rescue will be reduced by 10% from the overall fund.

③If the patient is transferred to a community health service center through a designated outpatient clinic, the overall fund payment rate shall be paid in accordance with regulations; if the patient is transferred to the outpatient department of the town (street) designated hospital or the outpatient department of the municipal designated specialist hospital, the payment ratio of the overall fund shall be reduced by 10%.

; If the patient is transferred to the outpatient department of the designated tertiary hospital in the city, the payment rate will be reduced by 20%; if the patient is transferred to other medical institutions, the overall fund will not pay.

④Except for the above situations, if the insured person goes to a medical institution other than the designated outpatient clinic for medical treatment on his own, the overall fund will not pay.