The money in the medical insurance card can be used to see a doctor in a designated medical insurance hospital, or to buy medicines in a designated medical insurance pharmacy. The social insurance agency will settle with the designated medical institution according to the actual medical expenses incurred in the personal account.
Taking Zhengzhou as an example, according to Article 25 of the Measures for the Basic Medical Insurance of Workers in Zhengzhou, the overall fund is mainly used to pay the hospitalization expenses, outpatient medical expenses for specified diseases and outpatient medical expenses for serious and serious diseases. Personal account is mainly used to pay for general outpatient medical expenses, drug purchase expenses and hospitalization medical expenses borne by individuals, etc. When the balance of personal account is insufficient to pay, the excess part shall be borne by individuals. The overall fund and individual account shall be accounted for separately, and shall not be misappropriated.
article 41 the medical expenses paid by the insured in the designated medical institutions with personal accounts shall be settled by social security cards. Social insurance agencies shall settle accounts with designated medical institutions according to the actual medical expenses incurred in individual accounts. The medical expenses incurred by the insured in the hospitalization of designated medical institutions shall be borne by the individual and settled by himself and the designated medical institutions; The part that should be paid by the overall fund shall be accounted for.
Extended information:
Measures of Zhengzhou Municipality on Basic Medical Insurance for Employees Article 22 The employee medical insurance premiums paid by employers and insured individuals constitute the employee medical insurance fund, which is divided into pooling funds and individual accounts.
Article 23 The employee medical insurance premiums paid by individual employees are fully credited to individual accounts, and part of the employee medical insurance premiums paid by the employer are credited to individual accounts according to different proportions:
(1) Those under 45 years old are credited to 1% of their payment base;
(2) Those who have reached the age of 45 and have not retired (resigned) will be included according to 2% of their contribution base;
(3) Retired (retired) personnel are included at 4.5% of their basic pension.
the rest is used as a unified fund, which is managed and paid by social insurance agencies.
Zhengzhou Municipal Government-Measures of Zhengzhou Municipality on Basic Medical Insurance for Employees