Medical insurance individual account used up can use the integrated account of the

Can you use your personal account for health insurance when it runs out?

When the money in the individual account of the health insurance card is used up, it must be borne by the individual. If the accumulated personal responsibility exceeds the prescribed amount, the individual will have to bear a different percentage of the medical fee for the exceeding part of the medical fee according to the type of hospital, and the rest will be paid by the coordinated fund.

The method of reimbursement from the integrated account is as follows:

1. When purchasing medicines, the cardholder goes to a designated health insurance institution to buy medicines, and the cost goes to the individual account;

The health insurance is divided into two accounts, the individual account, embodied in the money in the health insurance card, which can be used to buy medicines in designated pharmacies, the payment of outpatient expenses and hospitalization costs of the individual out-of-pocket part of the payments; the integrated account, which is managed by the health insurance center, the participants who have incurred expenses that meet the requirements of the health insurance center. center, the expenses incurred by the insured person in line with the local health insurance reimbursement will be paid by the integrated account;

2. When you go to the outpatient clinic, keep the original diagnostic certificates, medical records, report cards, and charging slips to go to the local social security institution for reimbursement;

When you go to the medical clinic, you will present your medical insurance card to the designated hospital to prove your participation in the insurance scheme, and at the checkout, you can pay for the part of the individual's out-of-pocket expenses with the

3. When you are hospitalized, you need to deposit a certain amount of money as a deposit, and when you are discharged from the hospital you will be reimbursed according to the reimbursement rate of the medical insurance, which is more or less than the amount of money you have been reimbursed.

The hospitalization reimbursement is based on the minimum payment line, which means that you need to pay for the money on your own, and you need to reimburse for the money that you have paid for the money that you have paid for the money that you have paid for the hospital, according to the local medical insurance regulations. According to the provisions of the local medical insurance reimbursement, the reimbursement rate is not the same everywhere, about 75%.

Medicare reimbursement ratio:

1. Medical expenses incurred in tertiary hospitals:

(1) the part of the starting standard to 30,000 yuan, the coordinated fund will pay 85%, and the employee will pay 15%;

(2) the part of the total of more than 30,000 yuan to 40,000 yuan, the coordinated fund will pay 90%, and the employee will pay 10%;

(3) the part of the total of more than 40,000 yuan, the coordinated fund will pay 90%, and the employee will pay 10%;

(3) For the portion exceeding 40,000 yuan, the integrated fund pays 95% and the employee pays 5%.

2. Medical expenses incurred in secondary hospitals:

(1) For the portion of the starting standard up to 30,000 yuan, the coordinated fund pays 87%, and the employee pays 13%;

(2) for the portion exceeding 30,000 yuan up to 40,000 yuan, the coordinated fund pays 92%, and the employee pays 8%;

(3) for the portion exceeding 40,000 yuan, the coordinated fund pays 97% and the employee pays 3%.

3. Medical expenses incurred in first-class hospitals as well as home hospital beds:

(1) For the portion of the starting standard up to 30,000 yuan, the coordinated fund pays 90%, and the employee pays 10%;

(2) For the portion of the amount exceeding 30,000 yuan and up to 40,000 yuan, the coordinated fund pays 95%, and the employee pays 5%;

(3) For the portion of the amount exceeding 40,000 yuan, the coordinated Fund pays 97% and the employee pays 3%.

4. The individual payment rate for retirees is 60% of the employee's payment rate.

In summary, the maximum amount paid by the basic medical insurance fund on a pro rata basis shall not exceed about four times the average salary of the city's employees in the previous year.

Legal basis:

Article 29 of the Social Insurance Law of the People's Republic of China

The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance agency with the medical institutions and the drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.

Article 28

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with national regulations.