What is the difference between self-funded and self-funded

The difference between self-funding and self-payment is as follows:

1. Different definitions:

(1) Self-payment refers to the part of medical expenses used by the insured to pay for the medical expenses below the starting line of the basic medical insurance fund, the medical expenses insufficiently paid for by the outpatient account, and the part of medical expenses proportionately paid for by the individual in the case of the basic medical insurance fund and medical subsidies for serious illnesses;

(2) Self-funding refers to medical expenses that are not included in the basic medical expenses that are not covered by the basic medical insurance; medical expenses for drugs that are not included in the drug list of the basic medical insurance; and medical expenses for the non-reimbursable part of the diagnostic and therapeutic items of the basic medical insurance.

2, the cost of different:

(1) out-of-pocket expenses, social security directory outside the cost, does not belong to the scope of reimbursement, including out-of-pocket drugs, out-of-pocket items and out-of-pocket services. For example, social security can not be reimbursed for targeted drugs, imported special drugs, accompanying bed fees, wristbands, etc., which need to be paid by the patient's own cash (WeChat, Alipay, bank card), and this part of the cost can not be offset by the balance of the personal account.

(2) Out-of-pocket expenses . Out-of-pocket expenses is a collective term for categorized out-of-pocket expenses + individual out-of-pocket expenses. Individual co-payment, the cost of the medical insurance catalog, the reimbursement rate outside the part. Generally, it refers to the cost below the starting line and above the cap line. In addition to the portion below the starting line and above the cap line that you have to bear, the reimbursement rate varies according to the level of the hospital. For example, the reimbursement rate for a tertiary hospital is usually up to 70%, and for a first-class hospital it can be up to 95%, with the remaining portion to be paid out-of-pocket. Categorized out-of-pocket, the reimbursable portion of the cost within the health insurance catalog. Inside the reimbursable part of the social security, which is usually referred to as Class A and Class B drugs, in fact, not fully reimbursed. According to the regulations, the individual also has to bear part of the cost, for example, Class B drugs or Class B medical services, social security can only reimburse 90%, the individual has to bear 10%. This part of the money, again, need to pay for themselves.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and resuscitations, will be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.