Basic medical insurance participants use the medical insurance program, the basic medical insurance fund to pay the cost of the benchmark. The part within the payment standard is shared proportionally between the participant and the medical insurance fund, and the part outside the payment standard is paid by the participant.
To put it simply, for some medical insurance programs, the medical insurance department will designate a medical insurance payment amount, and the money within this amount will be borne by the medical insurance and the participant according to the reimbursement ratio, while the money outside the amount needs to be solved by the participant himself. In the case where a patient buys a drug, consumable or service that is a selected, negotiated product, the amount paid by the health insurance is the price at which the patient buys the drug, then the patient doesn't have to come up with their own money outside the health insurance payment standard, and only needs to be reimbursed on a pro rata basis. For example, some very expensive negotiated drugs, health insurance payment standard is the national unified negotiated price, say how much is how much, sold to the patient when not allowed to increase the price, then directly in accordance with the provisions of the proportion of reimbursement. But sometimes, such as the collection of drug varieties, patients in the purchase of the same generic name of the non-selected drugs, the price may be a little higher than the health insurance payment standard, which involves the calculation of the amount of money beyond the payment standard. Not all programs have health insurance payment standards. Currently, only negotiated drugs, volume purchasing drugs, "two diseases" drugs, volume purchasing medical consumables and some medical services, only by the medical insurance department to provide a unified medical insurance payment standard. When using these items, the patient's reimbursement amount will be calculated according to the health insurance payment standard, and all other items will be directly reimbursed according to the relevant reimbursement level and proportion.