What is the difference between self-funded and self-funded medical insurance?

Out-of-pocket refers to the part of medical expenses that is completely borne by individuals, and out-of-pocket refers to the part of expenses that need to be borne by individuals within the scope of medical insurance payment.

First, self-funded medical insurance.

Self-funded medical insurance refers to the part of medical expenses that does not belong to the scope of medical insurance payment and needs to be fully borne by individuals. These expenses are usually due to the use of drugs, examinations, treatment items, etc. Outside the medical insurance catalogue. The specific amount of the self-funded part of medical insurance will vary according to the content of treatment, drugs or items used. For patients, the out-of-pocket part of medical insurance is usually a big expense, which requires economic preparation in advance.

Second, medical insurance payment.

The self-payment of medical insurance is a part of the expenses that individuals need to bear within the scope of medical insurance payment. This part of the cost is usually calculated according to the proportion stipulated by the medical insurance policy. For example, for some drugs or treatment projects, medical insurance may only pay part of it, and the rest needs to be paid by individuals themselves. The amount of out-of-pocket medical insurance will vary according to specific medical insurance policies, individual contributions and other factors.

In the actual process of medical treatment, self-payment and medical insurance self-payment are two interrelated but different concepts. Patients need to arrange medical treatment plans reasonably according to their own medical insurance situation and economic situation, try to avoid unnecessary out-of-pocket medical insurance expenses, and also understand the payment method and proportion of out-of-pocket medical insurance expenses, so as to make corresponding economic preparations.

In addition, in order to better reduce the financial burden of patients, the state is constantly improving the medical insurance policy, expanding the scope of medical insurance payment, and reducing the proportion of individual pays. At the same time, patients can also understand the medical insurance policy and choose designated medical institutions to reduce medical expenses.

To sum up:

Self-payment and self-payment of medical insurance are two important concepts in the process of medical insurance payment. Out-of-pocket refers to the part of medical expenses that is completely borne by individuals, and out-of-pocket refers to the part of expenses that need to be borne by individuals within the scope of medical insurance payment. Patients should understand and distinguish these two concepts in the process of seeking medical treatment, so as to better arrange their own medical treatment plan and economic preparation.

Legal basis:

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

Article 28 provides that:

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.

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

Article 30 provides that:

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.