What does the self-funded medical insurance card mean?

The self-financing and self-financing of medical insurance cards refer to:

1, the ego in medical insurance is divided into two parts: classified ego (ego 1) and personal ego (ego 2).

(1) Self-classification means that although the drugs or treatment expenses you use are in the medical insurance reimbursement catalogue, the medical insurance does not fully reimburse these drugs or treatment expenses, but reimburses them according to a certain proportion. After the medical insurance is reimbursed in proportion, the remaining expenses are your own expenses. For example, for Class B drugs, 90% can be reimbursed by medical insurance, and the remaining 10% belongs to graded self-funded expenses. Including the medical insurance deductible line, the expenses borne by individuals after medical insurance reimbursement in proportion exceed the expenses capped by medical insurance.

(2) Personal conceit refers to the part of expenses paid in advance, which is not within the scope of medical insurance reimbursement.

2, medical insurance at their own expense, refers to the medical expenses that are not included in the basic medical insurance payment scope; Using drugs outside the basic medical insurance drug list; Medical expenses that are not reimbursed by using the basic medical insurance treatment project.

Medical insurance reimbursement conditions

1. Confirm the insured status: before seeking medical treatment, you need to confirm that you have participated in local medical insurance, which can be confirmed by means of social security card and medical insurance certificate;

2. Medical category: Medical insurance generally only reimburses therapeutic medical behaviors, such as outpatient service, hospitalization, surgery and examination. Some cosmetic medical behaviors, such as dental beauty and plastic surgery, are usually not covered by medical insurance reimbursement;

3. Medical expenses: Medical insurance will only reimburse medical expenses that meet the requirements, such as medical expenses, medicine expenses, examination expenses, operation expenses, etc. Personal expenses, medical insurance will not be reimbursed;

4. Hospital qualification: Medical insurance will only reimburse the medical expenses of legally operated medical institutions, such as public hospitals and qualified private hospitals. Medical insurance will not be reimbursed for illegal medical institutions or clinics.

Generally speaking, medical insurance conceit and medical insurance self-financing are two different concepts. Self-insurance refers to the total part of all medical expenses that you need to bear after medical insurance reimbursement, and self-insurance refers to those expenses that are not covered by medical insurance reimbursement.

Legal basis:

People's Republic of China (PRC) social insurance law

second

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

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.