What is a coordinated payment?

Coordinated payment is to use the funds in the coordinated account to pay for the participant's related medical expenses. Account payment, that is, with the participant's medical insurance card in the pharmacy or outpatient clinic card spending behavior. The integrated management of health insurance, consisting of individual account and integrated account.

Payment standard:

Difference of the integrated payment standard:

①Participants outside the service time of the designated outpatient point of care, due to an emergency directly to the town (street) community health service center for medical treatment of the basic medical expenses incurred by the integrated fund in accordance with the provisions of the payment.

② participants directly to the town (street) community health centers outpatient rescue of basic medical expenses incurred, the integrated fund is required to pay; directly to the designated outpatient clinics and the town (street) community health centers outside of the city medical institutions outpatient rescue of basic medical expenses incurred, the proportion of the integrated fund to pay 10% lower.

③Through the designated outpatient point of referral to the community health service centers, the integrated fund in accordance with the provisions of the payment; referral to the town (street) designated hospital headquarters outpatient department or the municipal designated specialist hospital headquarters outpatient department, the integrated fund to pay the proportion of a reduction of 10%; referral to the city's designated tertiary hospitals headquarters outpatient department, the proportion of the payment of a reduction of 20%; referral to other health care institutions, the integrated fund will not be paid.

Related extensions:

Medicare integrated payment is to use the money in the integrated account to pay for the medical expenses of the participant; individual account payment is to use the money in the individual account to pay for the medical expenses of the participant.

Medicare is one of the most basic and common types of social security. But social security is not a panacea, it only provides the most basic protection.

One of the limitations of Medicare is that it limits the scope of reimbursement

Medicare is the most utilized of the social security reimbursements, so no matter whether it is the reimbursement amount or reimbursement scope, the limitations are also more.

Simply put, the Medicare reimbursement limitations, including the two fixed points, three catalogs, the starting line, the ceiling line, the reimbursement rate, the ceiling line and so on.

Expenses that meet the requirements of these restrictions are reimbursed.

For example, the three catalogs of health insurance stipulate the drugs, designated hospitals, reimbursement of diseases and the scope of medical treatment.

Second, the health insurance will not be reimbursed

1, self-medication

For example, do not go to the designated hospitals, or do not follow the requirements of the referral form.

2. Charges for services during the treatment period

such as fees for consultation, meals, nutrition, blood transfusion, heating and cooling.

3, intentional injury resulting in medical costs

The medical costs arising from car accidents, fights, alcoholism and other reasons.

4, orthopedics, plastic surgery, dentures, prosthetics, organ transplantation, named surgery fees, consultation fees, etc.

5, should be from the workers' compensation insurance, maternity insurance fund.

6. Medical expenses that should be borne by a third party.

Of course, the above is only common everywhere, the specific reimbursement should also follow the local detailed reimbursement policy.

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