Specifically, the overall payment of medical insurance refers to the overall planning and management of the medical expenses of the insured by the medical insurance fund, which ensures the use efficiency of the medical insurance fund and the reasonable distribution of funds while the insured enjoys the basic medical insurance benefits. The principle of overall payment of medical insurance is to pay the medical expenses of the insured according to a certain proportion according to the financial situation of the medical insurance fund and the provisions of the medical insurance policy. The specific payment proportion and standard vary with different regions and policies, but in general, the medical insurance fund pays a higher proportion, which can effectively reduce the medical burden of the insured and ensure their basic medical needs.
The use of medical insurance must meet the following conditions at the same time:
1, medical insurance payment needs to conform to the national drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses;
2. The overall payment of medical insurance needs to meet the deductible standard. Medical expenses below the deductible line need to be paid by individuals, and the part above the deductible line can be reimbursed;
3. The overall payment of medical insurance needs to conform to the scope of the medical insurance catalogue. Expenses outside the scope of medical insurance catalogue need to be paid by individuals at their own expense.
To sum up, the overall payment of medical insurance does not mean that all medical expenses can be paid in full, and there will generally be some conceit. At the same time, the payment scope and restrictions of medical insurance fund will be different according to different policies and regulations, and individuals should pay attention to abide by relevant regulations and requirements when enjoying medical insurance benefits.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.