What does the social security payment part include?

The difference between self-payment 1, self-payment 2 and self-payment is as follows:

1, self-payment 1: medical expenses that should be borne by individuals in proportion (including the amount above the deductible line and above the cap line);

2. Out-of-pocket expenses 2: the amount that needs to be borne by individuals in the Category B catalogue (such as Category B drug 65438+ 00% medical expenses borne by individuals);

3. Self-expense: medical expenses beyond the scope of reimbursement (i.e. drugs, diagnosis and treatment, service facilities).

Out-of-pocket refers to the medical expenses that are not included in the scope of basic medical payment, all of which are borne by individual employees, and are not included in the accumulated medical expenses (such as some nutrition and health products). Including: using drugs outside the basic medical insurance drug list; The use of basic medical insurance treatment project will not pay the medical expenses of the treatment project; Medical expenses that exceed the payment standard of basic medical insurance for medical services and the expenses incurred by medical service facilities that are stipulated not to be paid.

Out-of-pocket refers to the expenses paid by individuals in proportion according to the provisions of medical insurance, which are accumulated into the total expenses of personal medical expenses (such as special examination expenses such as CT and MRI, where individuals pay first 10% and the rest are reimbursed in proportion). Including: medical expenses below the threshold of designated basic medical insurance pooling fund and above the payment limit of outpatient pooling account; When the basic medical insurance and Medicaid funds for major diseases are co-ordinated, individuals will pay part of the medical expenses in proportion.

legal ground

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

Article 2 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 in case of old age, illness, industrial injury, unemployment and maternity. Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

skill

The above answer is only for the current information combined with my understanding of the law, please refer carefully!

If you still have questions about this issue, I suggest you sort out relevant information and communicate with professionals in detail.