1. If an employee is injured at work, before the work-related injury certification is issued, he or she will generally settle through ordinary medical insurance or self-pay. After the work-related injury is confirmed, the payment will be made from the work-related injury insurance fund.

If it was previously settled according to ordinary medical insurance, the difference will be made up; if it was settled according to self-pay, the full amount will be made up.

2. If you are not an employee injured at work, you cannot go through work-related injury settlement.

The work-related injury insurance fund is earmarked for special use.

Legal analysis: The formula for calculating the medical insurance reimbursement ratio is: (total expenses – expenses below the threshold – self-pay/self-pay items) × reimbursement ratio.

Medical insurance reimbursement has a deductible and a cap. If the reimbursement is below the deductible or above the cap, social medical insurance will not reimburse.

Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" meets the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses, and shall be deducted from the basic medical insurance fund in accordance with national regulations.

Pay.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.

The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.