What is the meaning of the individual account of medical insurance The difference between the individual account of medical insurance and the coordinated account

What is the meaning of individual medical insurance account

Individual medical insurance account refers to the special fund account set up by the medical insurance organization for individuals participating in the basic medical insurance, which is used to record the financing of their own medical insurance and reimbursement of their own medical expenses.

The full name of the medical insurance personal account is basic medical insurance personal account (Individual medical savings account), or personal account for short. Individual accounts are mainly used to record and store funds in individual accounts, and are used for personal medical consumption according to regulations. The main sources of individual account funds include: individual medical insurance premiums; a certain percentage of the social medical insurance premiums paid by the employer; some include the start-up funds of the individual account paid by the employer for the individual; and the interest income of the individual account funds generated with the increase in the number of years of insurance.

Individual account payment scope: It is usually used to pay for specific medical expenses of the insured, including outpatient expenses incurred by designated medical institutions; expenses for purchasing medicines at designated retail pharmacies; expenses below the starting standard of the integrated fund for inpatient and outpatient basic medical expenses of designated hospitals for specific items; and expenses that should be borne by the individual if they are above the starting standard. The use of individual account funds to pay for medical expenses should be in line with the scope of basic medical drugs, diagnostic and treatment programs, medical services and facilities and payment standards.

China's basic medical insurance for urban workers is managed on a coordinated basis and is divided into 2 accounts, namely, the coordinated account and the individual account, and the individual account here is the individual account of the medical insurance.

The difference between the individual account and the integrated account

First, the individual account is used for:

(1) outpatient and emergency medical expenses;

(2) the cost of medicines purchased from designated retail pharmacies;

(3) medical expenses below the starting standard of the integrated fund of the basic health insurance;

(4) medical expenses exceeding the starting standard of the integrated fund of the basic health insurance, in accordance with the standard of the basic health insurance. (4) Medical expenses exceeding the starting standard of the basic medical insurance fund, which should be borne by individuals according to the proportion.

Second, the co-ordination account is used for

(1) the medical expenses of hospitalization;

(2) the medical expenses within 7 days of hospitalization for those who are hospitalized after emergency rescue and hospitalization;

(3) the outpatient medical expenses for radiation therapy and chemotherapy for malignant tumors, kidney dialysis, and anti-rejection drugs after kidney transplantation.

Third, in the social security part of the unit contributions and individual contributions, unit contributions into the integrated account, individual contributions into the personal account, such as pension insurance unit to pay 20% of the employee's salary on the integrated account, the employee to pay 8% into the personal account. And medical insurance unit contributions in part will be transferred out of the employee's personal account (according to local regulations are different).

The money in the personal account is owned by the individual, and in the case of pension insurance, when the employee dies before the retirement age, the pension insurance personal account will be returned to the beneficiary. In medical insurance, the money in the individual account is used by the individual to pay for outpatient expenses, the individual's out-of-pocket portion of the social security medical provisions, purchase of medicines, etc., and the coordinated account is owned by the same person as the ****.

The latest policy on health insurance personal account:

The health insurance personal account can be used for family members!

The State Council executive meeting held on April 7, to determine the establishment of a sound employee basic health insurance outpatient *** relief protection mechanism measures to broaden the scope of use of individual account funds to reduce the burden of the masses of medical care.

The meeting pointed out that China's new round of health care reform has established the world's largest, benefiting more than a billion people in the basic health insurance network, to reduce the burden of the masses to seek medical treatment, to alleviate the high cost of medical care has played an important role. In recent years, and will involve many patients with hypertension, diabetes and other outpatient slow special diseases into the medical insurance reimbursement. The next step is to deepen the health care reform, enhance the basic employee health insurance mutual ****ji protection function, more outpatient costs into the health insurance reimbursement, further reduce the burden on patients.