What does the percentage of out-of-pocket medical insurance mean?

According to the relevant management regulations, the self-payment ratio refers to the percentage of the insured's expenses in the co-payment of medical expenses in the form of medical insurance institutions and patients sharing medical expenses. The so-called individual pays proportion refers to the proportion of medical expenses that the insured is allowed to pay in the medical insurance policy. Out-of-pocket ratio refers to every sum of money spent on medical treatment, some of which should be paid by oneself. The self-payment ratio of medical insurance is 0, which means that there is no need for individual payment, and all medical insurance expenses are paid by overall planning.

Out-of-pocket ratio refers to the percentage of out-of-pocket medical expenses borne by the insured under the form of medical expenses sharing between medical insurance institutions and patients. The so-called individual pays proportion refers to the proportion of medical expenses that the insured is allowed to pay in the medical insurance policy.

1. What is the reimbursement rate of Class B medical insurance?

The reimbursement rate of Class B medical insurance is 10% first, then 85% or 92%. The reimbursement rates of Class A and Class B medical insurance vary from place to place. Class b should pay part of its own expenses and reimburse part of it. The specific reimbursement ratio varies according to local policies and specific drugs. The medical insurance catalogue is selected according to the national essential drugs catalogue, and Class A and Class B are determined according to the price ratio of curative effect. 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.

Second, the proportion of hospitalization medical insurance reimbursement for cholecystitis

1 0.3 million yuan to110,000 yuan (inclusive) for medical expenses, 94% for large medical insurance premiums, and 6% for individuals; 2.65438+100,000 yuan to 200,000 yuan (inclusive) for medical expenses, with 96% for large medical insurance premiums and 4% for individuals; For medical expenses above 32,000 yuan, 98% is paid by large medical insurance premiums, and 2% is paid by individuals. In a year, the highest proportion of large medical insurance premiums is 300,000 yuan per person.

Third, how to use the money in employee medical insurance?

The money in the medical insurance card is a personal account, not how much the bank pays. The expenses paid by employees' medical insurance are divided into individual accounts and overall accounts. Personal accounts can be used for outpatient consumption or to pay their own expenses. The overall account shall reimburse large medical expenses such as hospitalization according to the prescribed proportion. Therefore, the medical insurance paid does not protect itself, and the state protects personal medical care. Taking Zhengzhou as an example, according to Article 22 of the Measures for Basic Medical Insurance for Employees in Zhengzhou City, the medical insurance premiums paid by employers and insured individuals constitute the employee medical insurance fund, which is divided into overall funds and individual accounts. Twenty-fifth overall fund is mainly used to pay for hospitalization medical expenses, outpatient medical expenses for specified diseases and outpatient medical expenses for serious diseases. Personal accounts are mainly used to pay for general outpatient medical expenses, drug purchase expenses and hospitalization medical expenses borne by individuals. When the personal account balance is insufficient to pay, the excess shall be borne by the individual. Pooled funds and individual accounts shall be accounted for separately and shall not be misappropriated.

Legal basis:

"Regulations on the supervision and administration of the use of medical insurance funds" seventeenth

The insured person should hold his medical insurance certificate for medical treatment and drug purchase, and take the initiative to show it for inspection. Insured persons have the right to require designated medical institutions to truthfully issue expense documents and related materials.

Insured personnel should properly keep medical insurance certificates to prevent others from using them. If it is necessary to entrust others to purchase drugs for special reasons, the identity certificates of the principal and the trustee shall be provided.

Insured persons shall enjoy medical security benefits according to regulations and shall not enjoy them repeatedly.

Insured persons have the right to request medical insurance agencies to provide medical insurance consulting services and put forward suggestions for improvement in the use of medical insurance funds.