Why does medical insurance have self-funded drugs?

(1) Provisions on reimbursement of medical insurance:

Medical insurance reimbursement is proportional. Not paying (expenses) is full reimbursement, and you don't have to pay for it yourself, but you can reimburse it in proportion according to the medical insurance regulations.

General medical reimbursement is divided into three categories, one is non-self-payment, and the other two are full self-payment (expense), that is, self-payment is not reimbursed.

And there are out-of-pocket expenses (expenses), that is, some of them can be reimbursed and some of them are not.

(b): Why do you have to pay for it yourself sometimes?

No self-payment, that is to say, all drugs are charged according to the reimbursement ratio. If you pay out of your own pocket, you must deduct the non-reimbursable money first.

The rest will be reimbursed in proportion. Although the receipt says no self-payment, medical insurance will pay according to a certain proportion.

You have to bear the rest yourself, which is why you have to pay for the extra one or two hundred dollars. For example, if you spend 1000 yuan,

There is no out-of-pocket expenses. If medical insurance covers 80% of your expenses, then you have to pay the remaining 20%, which is 1000 yuan.

Pay 800 yuan medical insurance, and you pay 200 yuan yourself. Not paying doesn't mean you don't have to pay. Similarly, 300 yuan paid 1 1,000 yuan for medicine.

Then 300 yuan will be deducted first, and the rest of 700 yuan will be reimbursed for 70% social security and 490 yuan. You personally bear the part paid by 300 yuan +700 yuan X30% = 5 10 yuan.

You have to pay 5 10 yuan for this medicine yourself.

(3) Note:

As can be seen from the example, whether there is out-of-pocket payment or not, individuals have to bear part of the medical expenses. It's not that the medicine says no money.

You really don't have to pay a penny. You still need to pay a certain fee according to your own proportion.

So when you take the bill to submit an expense account, you must know clearly in advance to avoid unnecessary disputes.