What is the difference between a pooled account and an individual account for medical insurance?

1. Personal accounts are used for:

1) Medical expenses for outpatient and emergency services;

2) the cost of purchasing drugs at designated retail pharmacies;

3) Medical expenses below the minimum payment standard of basic medical insurance;

4) Exceeding the basic medical insurance co-ordination ** minimum payment standard, according to the proportion of medical expenses that should be borne by the individual.

2. The pooled account is used for:

1) Medical expenses for hospitalization**;

2) If the patient is placed under observation for emergency rescue and admitted to hospitalization**, the medical expenses within 7 days of observation before hospitalization;

3) Outpatient medical expenses for radiation and chemistry of malignant tumors, kidney dialysis, and anti-rejection drugs after kidney transplantation.

Third, in the social security part of the unit payment part and the individual payment part, the unit payment will enter the overall account, and the individual payment will enter the personal account, such as the pension insurance unit will pay 20% of the employee's salary on the overall account, and the employee will pay 8% into the personal account. In the medical insurance, there is also a part of the unit payment will be transferred to the employee's personal account (according to local regulations).

The money in the personal account belongs to the individual, and when the employee dies before the retirement age in the pension insurance, the personal account of the pension insurance will be returned to the beneficiary. The money in the personal account in the medical insurance is used by the individual to pay for outpatient expenses, the out-of-pocket portion of the social security medical regulations, the purchase of medicines, etc., and the pooled account is considered to be jointly owned.

What is the overall account and individual account of medical insurance?

The differences between pooled accounts and individual accounts are as follows:

1.The concept is different: the pooled account refers to the mutual aid of various social insurance items. The personal account is to record the part paid by the insured person and the expenses transferred from the part paid by the unit, as well as the interest on these two parts.

2.The purpose is different: the money in the pooled account belongs to the individual. The personal account is the main basis for the insured person to receive the relevant benefits of the personal account when he or she goes through the retirement procedures, cross-overall transfer, surrender before retirement, settle abroad before retirement, or terminate the basic pension relationship after death.

3.It can be used in different ways: the pooled account is a monthly pension or a funeral grant and a bereavement pension to the surviving family, and the personal account can be withdrawn after retirement.

The features are not the same:

The pooled account is mainly used for reimbursement of medical expenses, such as hospitalization, referral from other places, outpatient chronic diseases or special diseases; The personal account is mainly used for small expenses other than medical insurance reimbursement, such as buying drugs at designated pharmacies, outpatient treatment, and personal out-of-pocket payment after reimbursement.

Funds are not the same:

Most of the funds are transferred to the overall account, and a small part of the funds are transferred to the personal account, and the allocation ratio of the overall account and personal account of the employee medical insurance is also different according to local laws and regulations, and the scope of use of the personal account is also different.

The regulations for withdrawing funds are not the same:

The money in the overall account cannot be withdrawn, but the money in the personal account can be withdrawn if the conditions are met, and the insured person dies or emigrates, or leaves the company and is transferred to work in other places, and you can apply to withdraw the money from the personal account of the medical insurance card.

If you are not qualified to pay employee medical insurance, you must at least pay a resident medical insurance, after all, a person who does not have medical insurance is equivalent to no guarantee. Finally, reminder: whether it is the money in the overall account or the money in the personal account, it can only be used for medical treatment, not for daily consumption.

[Legal Analysis].：1.Personal Account:

Medical expenses for outpatient and emergency services; the cost of purchasing drugs at designated retail pharmacies; Medical expenses below the minimum payment standard of basic medical insurance**; If the minimum payment standard of basic medical insurance is exceeded, the medical expenses that should be borne by the individual in proportion to the standard.

2.Pooled Account: Medical expenses for hospitalization**; If the person is placed for emergency rescue observation and is admitted to hospitalization**, the medical expenses within 7 days of observation before hospitalization are in the state; Outpatient medical expenses for radioactive and chemical** malignant tumors, renal dialysis, and anti-rejection drugs after kidney transplantation.

[Legal basis].Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers

Article 3 Establish basic medical insurance for urban employees, and implement a system that combines personal medical accounts with basic medical care.

Ownership of a personal account belongs to the individual. The ownership of the overall planning ** belongs to all the personnel participating in the basic medical insurance.

Article 28 The personal account is used to pay for medical expenses outside the scope of the overall payment; If the personal account is insufficient to pay, the person shall be responsible for it.

Article 29 The medical expenses for hospitalization for serious illness** shall be paid in the following ways: virtual or family.

1) In principle, the minimum payment standard shall be controlled at 9-11 of the average annual social wage of employees in cities, counties and autonomous counties in the previous year.

2) In principle, the maximum payment limit shall be controlled at 3-5 times the average annual social wage of employees in cities, counties and autonomous counties in the previous year.

3) Medical expenses above the minimum payment standard and below the maximum payment limit shall be mainly paid by the overall plan, and a certain proportion shall be borne by the individual. Appropriate consideration is given to the proportion of medical expenses borne by retirees.

The scope of serious illness, the specific standard of the minimum payment standard and the maximum payment limit, and the proportion of medical expenses above the minimum payment standard and below the maximum payment limit shall be determined by the provincial people.

The above is only the current information combined with my understanding of the law, please refer to it carefully!

If you still have questions about the problem, it is recommended that you organize the relevant information and communicate with a professional in detail.

The difference between the medical insurance personal account and the overall account [stupid as 1] The money in the personal account is the cost borne by yourself every month, and the money in the overall account is the basic use of the fees paid by the company; The money in the personal account can be used to pay the self-payment part when visiting the doctor and buying medicine, and the money in the overall account is used to pay for the reimbursement when seeing a doctor; The money of the personal account can be taken out on the basis of meeting the relevant conditions, and the money of the overall account cannot be taken out under any circumstances; The money in the personal account can be used not only by oneself but also by the family, and the money in the overall account can only be reimbursed when the insured person is sick and hospitalized.

Hello dear, the medical insurance pooling account and the individual account are two important components of China's social medical insurance system. The medical insurance pooling account refers to the centralized management account of social medical insurance, which is mainly composed of national and local contributions, as well as the payment, pooling and other income of the insured. The pooled account is mainly responsible for the balance of income and expenditure of medical insurance, including income, balance, expenditure, etc.

The personal account refers to the account formed by the insured person when paying the medical insurance premium, which belongs to the personal deficiency and is used to supplement the payment amount of the medical insurance pool. The funds in the personal account can be used to pay for medical expenses such as medicines, medical services and examinations, but the personal account can only be used to pay for part of the expenses, and the remaining expenses need to be paid by the finchfiber medical insurance pooling account. In general, the medical insurance pooling account and the individual account have different roles in the medical insurance system.

The medical insurance pooling account is mainly used to balance the income and expenditure of medical care**, while the personal account is set up to improve the ability to pay for medical insurance and reduce the medical expenditure of the insured.

The funds in the medical insurance pooling account are mainly used to pay for the medical insurance fees paid by the state, local governments and enterprises, etc., and are used to pay for various expenditures of medical insurance; The personal account refers to the medical insurance fees paid by the insured person, which is used to pay for personal medical expenses. 2.The funds are used differently:

The medical insurance pooling account is mainly used to pay for the medical insurance expenses of medical institutions and medical personnel, such as medical service fees, drug costs, diagnosis and treatment costs, etc.; The personal account is mainly used to pay for personal medical expenses, such as outpatient expenses, hospitalization expenses, etc. 3.Payment methods are different:

The payment method of the medical insurance pooling account is mainly to pay the medical service fees directly to medical institutions and medical personnel, that is, to pay according to the charging standards of different medical service items; On the other hand, the payment method of the personal account is that when the individual receives a medical visit, the individual pays part of the medical expenses first, and then pays the amount from the personal account. 4.The scope of use is different:

The scope of use of the medical insurance pooling account is relatively wide, including medical institutions, medical personnel, drug costs, diagnosis and treatment costs, etc.; However, the scope of the personal banquet account is relatively narrow, mainly limited to the medical expenses of the insured person.