The reason why the medical insurance pooling account is accumulated every year is to protect the medical rights and interests of the insured. In the medical insurance system, the medical insurance expenses paid by the insured will be included in the medical insurance pooling fund according to a certain proportion. This part of the funds is mainly used to pay the medical expenses of the insured, including hospitalization, outpatient service, medicines and other expenses. Because the medical expenses are continuous, the amount in the medical insurance pooling account needs to be accumulated year by year to cope with the future medical expenses.
Medical insurance reimbursement methods are as follows:
1. Before seeing a doctor: Before seeing a doctor, you need to confirm the type and scope of your medical insurance, choose medical institutions and doctors that meet the medical insurance policy, and ensure that medical expenses can be reimbursed;
2. During medical treatment: during medical treatment, you need to fill in your basic personal information and medical conditions accurately, and provide your medical insurance card and related certification materials to doctors and medical institutions;
3. Reimbursement application: After seeing a doctor, you need to submit an application for reimbursement of medical expenses to the local social insurance management center or medical insurance office, and provide relevant medical expenses bills and supporting materials, such as outpatient invoices, prescription notes, medical records, etc.
4. Reimbursement review: medical insurance institutions review the application for reimbursement of medical expenses, check the information such as expenses and illness, and determine the proportion and amount of reimbursement;
5. Reimbursement payment: After approval, the medical insurance institution will pay the reimbursement amount to the applicant's bank account or medical insurance card.
To sum up, the medical insurance pooling account is accumulated every year to protect the medical rights and interests of the insured and ensure timely medical security when needed. Therefore, the insured should actively pay medical insurance premiums and understand the relevant provisions of medical insurance policies in order to better enjoy medical insurance benefits.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 23
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.