According to the decision of medical reform in the State Council, pooling funds and individual accounts should delimit their respective payment ranges and be accounted for separately, and shall not occupy each other. At the same time, determine the minimum payment standard and maximum payment limit of the overall fund. Qifubiaozhun is controlled in principle at about 10% of the average annual salary of local employees, and the maximum payment limit is controlled at about 4 times of the average annual salary of local employees. According to the regulations, the specific Qifubiaozhun and the maximum payment limit of the overall fund, as well as the personal burden ratio of medical expenses above the Qifubiaozhun and below the maximum payment limit, are determined by the overall planning area in accordance with the principle of "balance of payments".
Personal account payment scope: first, basic medical expenses for outpatient and emergency departments; Second, the cost of purchasing drugs from designated retail pharmacies with prescriptions; Third, among the basic medical expenses for specific items of hospitalization and outpatient service, the medical expenses below the Qifubiaozhun of the overall fund, the medical expenses above the Qifubiaozhun and below the maximum payment limit should be borne by individuals in proportion, and can also be used for medical expenses exceeding the maximum limit.
The main expenditure of the overall fund. Of course, medical expenses should also comply with the relevant provisions of the scope of basic medical drugs, the scope of diagnosis and treatment projects, the scope of medical service facilities and payment standards.