The difference between self-funded part and self-funded part of medical insurance

Legal analysis: self-payment 1 is the self-payment part within the scope of medical insurance reimbursement, including the amount below the deductible line and the individual self-payment part after medical insurance reimbursement above the deductible line. Self-funded 2 is a self-funded part, which is not within the scope of medical insurance reimbursement.

Because medical insurance reimbursement is usually not 100% reimbursement, but there are the following situations:

1. Drugs and articles at one's own expense after deducting certain expenses (according to the drug list, drugs are divided into three categories: A, B and C, of which A is the most reimbursed, and C may be all or most at one's own expense; Some inspection items are also at their own expense).

2. In reportable items, a deductible line should be deducted first, which is usually several hundred yuan, and the part exceeding the medical expenses can be reimbursed.

After deducting the deductible, you may only be reimbursed a certain percentage, such as 20%, 50%, 90%, etc. According to different regulations, the rest is paid by individuals themselves.

4. There is also a capping line, and the reimbursement amount cannot exceed the capping at most, which is generally tens of thousands of yuan. The part above the capping line should also be paid by individuals or other medical assistance.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment item list, medical service facilities standard and emergency and rescue medical expenses, and shall be paid by the basic medical insurance fund according to state regulations.