The medical insurance pooling fund refers to the fund allocated according to a certain proportion from the basic medical insurance premium paid by the unit, which belongs to all the insured persons, and is centrally managed and uniformly adjusted by the social insurance agency, and is mainly used to pay the medical expenses, operation expenses, nursing expenses and basic inspection fees of the insured employees. The medical insurance fund shall be stored in a special account for special purposes, and no unit or individual may misappropriate it.

Raising and spending are two keys to ensure the safe and normal operation of the fund. Financing is the basis of the operation of medical security system. Only by raising the required funds on time and in full can the normal operation of the system be guaranteed. The proportion of funds raised is based on the local living and medical consumption level, and the future development trend is also considered. Therefore, when determining the overall level, we must carefully investigate and analyze it to be accurate and appropriate. Under normal circumstances, the level of financing should be slightly higher than the level of medical consumption, achieving a slight surplus. If there are mistakes or poor analysis in the investigation and analysis, or the future trend of medical expenses cannot be correctly predicted, and the financing level is lower than the predetermined medical consumption level, there may be overdraft risk in the operation of funds.

Can outpatient medical expenses be paid by medical insurance pooling fund?

According to medical insurance regulations, outpatient expenses are paid by personal accounts. However, considering the high cost of outpatient service for some chronic diseases and the large scale of examination and treatment, it is stipulated that the expenses of special examination and treatment and specific outpatient service items can be paid by the overall fund after application and approval.