Medical insurance settlement refers to the process in which medical insurance institutions, according to the medical service information and cost information provided by medical institutions, verify and calculate the medical insurance fund payment part and the individual pays part, allocate the medical insurance fund payment part to medical institutions, and collect the individual pays part from individuals at the same time. Simply put, after seeing a doctor in a medical institution, the medical expenses are divided into the part paid by the medical insurance fund and the part paid by the individual, and then the medical insurance institution and the individual bear the corresponding expenses respectively.

At the time of medical insurance settlement, individuals need to show their medical insurance cards and valid identity documents, and make settlement at the charging window of medical institutions. Medical institutions will calculate the self-funded part that individuals need to pay according to their own medical insurance information and actual treatment situation, and charge corresponding fees to individuals. At the same time, medical institutions will separate the payment part of the medical insurance fund and the personal payment part, and allocate them to medical insurance institutions and medical institutions.

The use of medical insurance standards usually includes:

1. Reimbursement scope: The medical insurance reimbursement scope refers to the medical expenses in medical insurance coverage, including hospitalization, outpatient service, basic medical care and other expenses. The specific scope of reimbursement may vary according to different regions and types of medical insurance, and it is necessary to consult the local medical insurance department or relevant institutions;

2. Reimbursement ratio: The medical insurance reimbursement ratio refers to the proportion of medical expenses paid by the medical insurance fund, which is generally divided according to different items and standards and formulated by the local medical insurance department or relevant institutions. Different regions and different types of medical insurance may have different reimbursement rates;

3. Reimbursement limit: the medical insurance reimbursement limit refers to the maximum amount of medical expenses paid by the medical insurance fund, and the part exceeding this limit needs to be borne by individuals. Different regions and different types of medical insurance may have different reimbursement limits;

4. Use of medical institutions: Medical insurance stipulates some designated medical institutions. Insured people need to choose designated medical institutions for medical treatment, otherwise they may not be able to enjoy medical insurance reimbursement. The designated medical institutions in different regions and types of medical insurance may be different.

To sum up, the use standard of medical insurance may be different due to different regions and policies, and the specific standards shall be subject to the provisions of local medical insurance departments or relevant institutions.

Legal basis:

Article 64 of People's Republic of China (PRC) Social Insurance Law

Social insurance funds include basic endowment insurance fund, basic medical insurance fund, industrial injury insurance fund, unemployment insurance fund and maternity insurance fund. In addition to the basic medical insurance fund and maternity insurance fund combined accounting, other social insurance funds are accounted for separately according to social insurance types. Social insurance funds implement a unified accounting system throughout the country. The social insurance fund is earmarked for special purposes, and no organization or individual may occupy or misappropriate it. The basic old-age insurance fund will gradually implement national overall planning, and other social insurance funds will gradually implement provincial overall planning. The specific time and steps shall be stipulated by the State Council.