1. The medical insurance pooling fund 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 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.

2. Medical insurance fund refers to the special fund raised by the state from units and individuals for basic medical insurance for employees in accordance with relevant national regulations by the medical insurance agency in order to ensure the basic medical care of employees.

The basic medical insurance fund consists of two parts: social pooling fund and personal account, which are paid jointly by the employer and individual employees according to a fixed proportion.

Sources of basic medical insurance funds: (1) Administrative agencies are arranged by finance at all levels.

(2) Public institutions with financial supply shall be arranged by the finance department at all levels according to the financial subsidies and business income. Other public institutions shall be disbursed from the medical funds drawn from business income or operating income.

(3) Enterprises spend on employee welfare fees.

(4) The basic medical insurance premiums for laid-off employees of enterprises who enter the re-employment service center, including employer contributions and individual contributions, are paid by the re-employment service center based on 60% of the average social salary of employees in the previous year in the coordinating area.

(5) The medical insurance premiums for those who are temporarily employed, are on long leave, have not entered the re-employment service center, are on leave without pay, etc. shall be collected and paid by their original unit.

Management of Medical Insurance Funds The management of basic medical insurance funds is related to the normal operation of the entire basic medical insurance system and the vital interests of employees. To strengthen fund supervision, we must start from the system and focus on five links: First, we must grasp the management of basic medical insurance funds

In financial management, basic medical insurance funds must be included in special financial accounts, and management of revenue and expenditure must be implemented on two lines. Special funds must be earmarked and must not be misappropriated. Secondly, we must focus on the internal management of social insurance agencies and establish and improve budget and final accounting systems and financial accounting systems.

and auditing system; thirdly, we must ensure the safety and integrity of the basic medical insurance fund. The funds for social insurance agencies cannot be withdrawn from the fund and must be settled by local fiscal budgets; fourthly, we must ensure the administrative supervision and auditing of basic medical insurance.

The labor and security departments and financial departments at the national level must strengthen the supervision of funds, and the audit departments must regularly audit the fund income, expenditures and management of social insurance agencies; fifth, we must strengthen social supervision of basic medical insurance funds, and coordinate regions to establish

The medical insurance fund supervision organization is attended by representatives of relevant government departments, employers, medical institutions, trade unions and relevant experts to strengthen social supervision.

3. Establish a basic medical insurance pooling fund and personal accounts. It is necessary to establish a basic medical insurance pooling fund and personal accounts.

The basic medical insurance fund consists of a pooled fund and individual accounts.

All basic medical insurance premiums paid by individual employees will be credited to their personal accounts.

The basic medical insurance premium paid by the employer is divided into two parts, one part is used to establish a unified fund, and the other part is transferred to the personal account.

The proportion transferred to the personal account is generally about 30% of the employer's payment. The specific proportion is determined by the coordinating region based on factors such as the payment scope of the personal account and the age of the employee.

The overall fund and individual accounts must delineate their respective payment scopes and account for them separately, and must not crowd out each other.

It is necessary to determine the minimum payment standard and maximum payment limit of the overall coordination fund. In principle, the minimum payment standard is controlled at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled in principle at about 4 times the average annual salary of local employees.

Medical expenses below the minimum payment standard shall be paid from a personal account or paid by the individual out of pocket.

Medical expenses above the minimum payment standard and below the maximum payment limit are mainly paid from the overall fund, and individuals also have to bear a certain proportion.

Medical expenses exceeding the maximum payment limit can be settled through commercial medical insurance and other channels.

The specific minimum payment standard, maximum payment limit of the overall planning fund, and the proportion of personal burden of medical expenses above the minimum payment standard and below the maximum payment limit are determined by the overall planning area based on the principle of determining expenditure based on revenue and balancing revenue and expenditure.