The overall payment in medical insurance can only be used to pay for hospitalization and outpatient treatment of some chronic diseases. The overall fund has a minimum payment standard and a maximum payment limit, and the personal account is mainly used to pay the general outpatient expenses.
The basic medical insurance fund shall, in principle, implement municipal co-ordination. The employer's contribution ratio is about 6% of the total salary, and the individual contribution ratio is 2% of my salary. Part of the basic medical insurance premium paid by the unit is used to establish the overall fund, and part of it is included in the personal account.
The basic medical insurance premiums paid by individuals are included in individual accounts, and the overall fund and individual accounts bear different responsibilities for payment of medical expenses.
What is the main function of overall medical insurance?
The medical insurance pooling fund is mainly used to pay the outpatient and inpatient medical expenses of special diseases, which belongs to the scope of basic medical insurance payment. We can't pay the general outpatient expenses and all self-funded items, and we can't pay the medical expenses caused by illegal crimes, alcoholism, suicide, self-mutilation, work-related injuries, maternity, traffic accidents, medical accidents and other liability accidents. The medical insurance fund belongs to all insured persons, and it is stored in special accounts and earmarked for special purposes, and no unit or individual may misappropriate it. The overall fund is mainly used for medical expenses such as hospitalization of insured persons, emergency rescue in non-designated hospitals, referral from different places (hospitals), resettlement in different places, and special disease clinics.
To sum up, in some areas, part of the settlement is made immediately, and the insured person does not need to pay in advance. In some areas, the insured pays in advance and then reimburses.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 27
Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.