1, there may be differences in the overall amount of medical insurance in different regions. For example, in a natural year of medical insurance for employees in Changsha, the accumulated minimum payment standard of outpatient service for employees shall not exceed that of 300 yuan, and the maximum payment limit for employees shall be 1500 yuan, and the maximum payment limit for retirees shall be 2,000 yuan.
2. Daily limit standard of medical insurance pooling fund payment: the first, second and third-level medical institutions are 30 yuan, 40 yuan and 50 yuan respectively.
3. The annual maximum payment limit of the employee basic medical insurance pooling fund is 6.5438+0.8 million yuan. After the insured suffers from a serious chronic disease in the outpatient department and high medical expenses in the hospital, the personal burden that meets the scope of serious illness insurance is accumulated, reimbursed by stages and settled by time in an insurance year.
Social factors that form the risk of medical insurance pooling fund;
The existing medical insurance system in China is gradually transformed from the former public medical care. At present, the payment of medical insurance is completed by the insured, medical institutions and medical insurance agencies. The opacity of medical consumption makes it difficult for medical supervision institutions to accurately define the value of medical consumption and the rationality of consumption content, which makes it very difficult for the overall fund to pay medical expenses normally and accurately.
Under the current situation, the financial input of designated medical institutions remains unchanged or even decreases, and its economic benefits mainly depend on its own income-generating ability, which inevitably makes medical institutions regard obtaining economic benefits as an extremely important pursuit goal.
To sum up: the overall medical insurance quota refers to the upper limit of the medical insurance fund used to pay the medical expenses of the insured. There are many factors to be considered in determining and adjusting the overall amount of medical insurance. First of all, according to the needs of the insured and the level of medical expenses, combined with the sustainability of the medical insurance fund, scientific evaluation and calculation are carried out. Secondly, we need to consider the adjustment of medical insurance policy and the development trend of medical services. The determination and adjustment of the overall amount of medical insurance is usually made by relevant government departments, medical insurance institutions and expert committees for comprehensive research and decision-making. According to factors such as economic development, population change and medical technology progress, it can be evaluated and adjusted regularly or when necessary. Ensure that the overall amount of medical insurance is reasonable, fair and sustainable, and provide necessary medical security for the insured.
Legal basis:
Law of the People's Republic of China on the Protection of Disabled Persons
Article 18
Local people's governments at various levels and relevant departments shall, according to needs, set up rehabilitation departments in medical institutions in a planned way, organize rehabilitation institutions for the disabled, and carry out rehabilitation medical treatment and training, personnel training, technical guidance and scientific research.
The establishment of the overall medical insurance quota is to ensure the sustainability and fairness of the medical insurance fund. It controls the growth of medical expenses and avoids the excessive burden of the fund. When the insured enjoys medical insurance benefits, the amount paid by the fund shall not exceed the overall amount. The specific amount varies according to different regions and policies. Insured personnel need to understand the policy, plan medical expenses reasonably and make full use of medical insurance benefits. The determination and adjustment of the overall amount of medical insurance need to comprehensively consider many factors to ensure the rationality, fairness and sustainability of medical insurance.