The difference between self pay and self payment in legal instruments

The former means to pay by yourself, and the latter means to be responsible for yourself.

The object of the disposition of the act, that is, the object is different, pays for the expenses and is responsible for it.

Individual self-payment: (XJB) refers to the sum of the total amount of the project with a deductible ratio greater than 0 and less than 1 and the amount of the project after the price limit ratio is calculated for the part of the excess with a limit (single item) with a deductible ratio of 0.

It is within the scope of medical insurance payment but should be paid by the individual in advance, such as Class B drugs, Class B medical service items and transfer to other places for medical treatment, which require the individual to pay a certain percentage first.

The expenses within the outpatient deductible segment (the resident medical insurance pays for the outpatient outpatient) and the inpatient deductible line are paid by the individual.

Self-pay is to pay everything yourself.

Bear the consequences at your own expense It is up to you to take all the responsibilities.

One refers to the payment.

A straightforward statement of responsibility (including all costs, of course) is a bit more subtle.

1. The scope of payment is different

"Self-paying" refers to the medical expenses within the scope of medical insurance settlement; "Classified self-responsibility" refers to the basic medical insurance to pay part of the cost items, the insured person according to the prescribed proportion or difference for cash to pay the cost.

2. The cost is different

"Self-paying" refers to the expenses that are borne by the individual according to the provisions of the medical insurance after deducting the "classified self-bearing" expenses; "Classified self-pay" refers to the cost of medicines, medical services, bed fees, etc.

Self-pay: refers to medical expenses that are not included in the scope of basic medical payment; The cost of drugs that are not included in the list of drugs of the basic medical insurance is used; If the basic medical insurance diagnosis and treatment items are used, the medical expenses of part of the diagnosis and treatment items will not be paid; Medical expenses that exceed the standard payment standard of medical service facilities under basic medical insurance, as well as expenses incurred by medical service facilities that are not covered by regulations.

Self-care: refers to the medical expenses that are included in the scope of basic medical insurance payment and should be paid by individuals first.

Self-responsibility: refers to the medical expenses used by employees to pay for the outpatient account below the minimum payment standard of the basic medical insurance co-ordination ** and insufficient payment in the outpatient account (currently excluding enterprise employees); When the basic medical insurance co-ordinates** and the medical treatment (i.e. medical assistance) subsidy for critical illness, the individual pays part of the medical expenses on a pro-rata basis.

The medical insurance has different reimbursements for different drugs: 1. The drug is in the medical insurance catalogue and can be included in the reimbursement in full. 2. The drug is in the medical insurance catalog, but a certain percentage of self-payment must be deducted before the amount is reimbursed.

3. If the drug is not in the medical insurance catalog, it cannot be reimbursed, and all of it must be paid for by yourself. This results in different out-of-pocket amounts.

What is the difference between paying one and paying two out of pocket? Oh, obviously, to get rich is to pay for yourself, well, to pay for yourself, in fact, you also pay for yourself.

It is like this: Class A drugs can enjoy full reimbursement (all are included in the medical insurance base, and within 1800 per year are also self-paying), Class C needs to be fully self-paid, and Class B is proportionally included in the medical insurance base, Beijing is responsible for 92% of the medical insurance, and the proportion of 8% is borne by the self-responsibility, or according to different Class B drugs. Then the self-payment of this category B is 8% of this part, and 92% of the cost included in the medical insurance is less than 1800 yuan per year, which is the self-payment one, and more than 1800 is paid by the medical insurance.

In the case of hospitalization, the minimum payment is marked 1300 yuan, which may be less than 1300 yuan, which is paid by oneself, and other expenses are paid by medical insurance and self-pay according to the proportion of A, B and C drugs and examinations.

Ah, there should be no difference between this, it's just two channels of payment.

4. Personal responsibility: refers to the expenses paid by individuals in proportion to the part above the outpatient self-payment section or hospitalization minimum payment standard, and the expenses paid by individuals in proportion to special diseases, and the expenses paid by individuals in proportion to out-of-hospital examinations (**).

I hope it can help you

In medical insurance, the individual pays, the individual pays, the individual pays, the personal bears, the difference between them is the personal self-pay, which refers to the need for personal care, the personal responsibility, the personal responsibility, the personal expense, the personal expense, the personal expense, the personal expense, the personal expense, the personal responsibility, the personal responsibility.

Medical invoices are typed with some medical insurance amounts.

Self-payment refers to the expenses borne by all the expenses outside the scope of reimbursement (higher than the reimbursement limit of self-financed drugs outside the catalog);

Self-payment refers to the expenses that need to be borne within the scope of reimbursement (general class B drugs or class B medical service items require self-payment of 10% of the invoice details of the department and 10% of the self-payment of class B drugs);

Within the scope of self-reimbursement, reimbursement according to the medical insurance policy must bear the cost of the starting line, and bear the meaning of self-payment.

Medical invoices often include these medical insurance amount items.

Personal out-of-pocket expenses refer to all expenses borne by individuals outside the scope of reimbursement (such as out-of-pocket drugs and expenses exceeding the maximum reimbursement limit);

Personal out-of-pocket payment refers to the expenses that are within the scope of reimbursement but need to be borne by the individual (generally Class B drugs or Class B medical service items, required).

For example, printing "10% B" in the drug details on the invoice in Shanghai is 10% for Class B drugs);

Personal self-responsibility is the reimbursement scope according to the medical insurance policy will not be reimbursed for the expenses that must be borne by the individual, which is generally the starting line.

Personal responsibility and personal self-pay is a meaning.

This is according to the relevant laws and regulations of the state, and the state has detailed classification regulations, and the specific classification is unknown. Most of the drugs that regulate physical fitness, such as instrument testing, the use of imported stents, imported drugs, blood transfusions, and tonics, are classified as self-payment, and only miscellaneous expenses such as prescription drugs and infusions, as well as the use of domestic drugs and beds, are included in the reimbursement category.

It is mainly a matter of use, and some medical insurance cannot be reimbursed.

The out-of-pocket payment of medical insurance hospitalization settlement is the part of the medical expenses that the individual needs to bear by himself, including the amount of the minimum payment line, the out-of-pocket amount beyond the reimbursement ratio of drugs, and the out-of-pocket amount of self-paid drugs or diagnosis and treatment items, and Class B diagnosis and treatment items (including examination fees, surgery fees, material costs, etc.) in addition to the specified reimbursement ratio.

Proportional self-responsibility is based on the different types of medical insurance (including resident medical insurance, employee medical insurance, retired employee medical insurance, NCMS, etc.), and the reimbursement ratio of individuals is also different, and proportional self-responsibility is part of the cost in the medical insurance reimbursement catalogue but must be borne by the individual (generally 10%-20% of the part of category B items needs to be paid by the individual).

Medical invoices often include these medical insurance amount items.

The difference is that the categories targeted are different.

1. Personal self-payment is mainly a part of the expenses that individuals need to bear within the scope of reimbursement, which are generally Class B drugs or Class B medical service items.

2. Personal conceit refers to the starting line, medical insurance is insurance, not a package, not all expenses can be reimbursed, there is a deductible, for example, the deductible is 10,000, then you spend less than 10,000, medical insurance is not reported, if you spend 10,000, then medical insurance reimbursement 3000

For example, if you spend 30,000 yuan on hospitalization, according to the medical insurance policy, the personal responsibility is 10,000 yuan, then the medical insurance should reimburse 20,000 yuan, but among the 30,000 yuan, there are class B drugs or class B items, then the medical insurance will deduct the deductible (the part that the individual is responsible for) and the cost of class B drugs or class B items (the individual pays), and then reimburse them proportionally.

The following diagram is clearly expressed, you can refer to it.

When settling with a medical insurance card, the balance in the card is used up and enters the personal self-responsibility section, the self-bearing amount standard is different from place to place, and all expenses in this stage are borne by the individual, and after exceeding the deductible amount standard, it enters the proportional self-bearing section, and the expenses incurred will be 10%-20% according to the hospital level.

Personal out-of-pocket payment, that is, some of the drugs you use are drugs that are outside the medical insurance, and you need to pay for them yourself and cannot be reimbursed. The pro-rata self-paid drugs are partially reimbursed by the medical insurance, and the self-paid part is reimbursed in proportion to the terms of the medical insurance.

There are many expenses that are not reimbursed when you are hospitalized, such as bed fees, bed fees, nursing fees, and other expenses that are not reimbursed, as long as you need to pay for them.

The personal responsibility when using medical insurance to make hospital settlement refers to: the part that cannot be included in the overall planning belongs to the self-paid items (such as self-financed drugs, air conditioning fees, etc.), and the proportional self-responsibility refers to the fact that you need to bear the part other than after you participate in the insurance and enjoy the overall planning ratio.

Self-pay: This part of the drugs, items, and materials is not covered by medical insurance, and needs to be paid in full by the insured.

Self-payment: Although some drugs, projects and materials are included in the scope of medical insurance, the insured person needs to pay a certain proportion first: such as 10% of the drug and 30%-40% of the material. The money paid by this part of the insured person is called self-care

Personal responsibility: The cost of inclusion in medical insurance has a certain reimbursement ratio, such as about 90% of the hospitalization reimbursement for retired employees, and the remaining 10%, as well as the minimum payment section and other expenses are taken care of by the patient, and they also have to pay by themselves, which is generally the starting line.

Personal Responsibility: Same as personal self-payment.

Personal payment means that you can't pay with the money in your account, you need to pay with cash personally.

That is, the part that asks you to take out your own wallet to pay the bill on the spot.

Other expenses are deducted from the balance of the health insurance card.

First of all, medical insurance here refers to the medical insurance for urban employees or residents in the national social security, not the concept in commercial reimbursement. Secondly:

The principle of medical insurance: low level, full coverage. So not all medical care is reimbursed.

Then you can understand the concepts above you. Self-pay: This part of the drugs, items, and materials are not covered by the medical insurance, and need to be paid in full by the insured person.

Self-conceit: Although some drugs, projects, and materials are included in the scope of medical insurance, they need to pay a certain proportion first: such as 10% of drugs and 30%-40% of materials.

The money paid by this part of the insured is called self-care: the expenses included in the medical insurance have a certain reimbursement ratio, such as about 90% of the hospitalization reimbursement for retired employees, and the remaining 10%, as well as the minimum payment period and other expenses are borne by the patient. It's also to pay for yourself.

First of all, medical insurance is reimbursed according to the percentage of the cost, and the specific percentage of reimbursement for different medical insurance may be different; The same medical insurance will have different levels of reimbursement in different levels of hospitals and different regions; Medical insurance is divided into the following situations:

1. ** that is not within the scope of medical insurance reimbursement (the patient needs to bear all the ** expenses) 2. It is within the scope of medical insurance reimbursement, but the reimbursement amount is limited, and the part outside the reimbursement amount (exceeding the maximum amount that can be reimbursed can no longer be reimbursed).

3. Within the scope of medical insurance reimbursement, but the reimbursement amount is limited, and the part within the reimbursement amount (which does not exceed the maximum amount of reimbursement and can be reimbursed proportionally).

Self-pay refers to the first case above; Deductible refers to the second case above.

Differences between self-pay and self-pay:

1. Self-payment is stipulated that it is not allowed to enter the social security settlement scope, and all the settlement scope is paid by yourself.

2. Self-payment is the remaining part after reimbursement according to a certain percentage.

Self-payment: 1. Medical expenses that are not included in the scope of basic medical payment;

2. The cost of drugs outside the list of drugs of basic medical insurance is used;

3. If you use the diagnosis and treatment items of basic medical insurance, you will not pay the medical expenses of some of the diagnosis and treatment items; Medical expenses in excess of the standard part paid by the medical service facilities of the basic medical insurance; and expenses incurred by medical facilities that are not covered by the regulations.

Self-responsibility: 1. It refers to the medical expenses used by employees to pay for the medical expenses below the minimum payment standard of basic medical insurance and insufficient payment in the outpatient account (currently excluding enterprise employees);

2. When the basic medical insurance is co-ordinated** and the medical treatment (i.e. medical assistance) subsidy for major illnesses, the individual shall pay part of the medical expenses in proportion.

Out-of-pocket expenses are paid out of your own pocket and do not need to be reimbursed by insurance, such as the bottom line part. The out-of-pocket payment is stipulated in the insurance rules, this part is paid by yourself, and the insurance does not bear it, such as the imported drug "Class C Medicine" of medicine.

Personal out-of-pocket expenses refer to all expenses borne by individuals outside the scope of reimbursement (such as out-of-pocket drugs and expenses exceeding the maximum reimbursement limit);

Personal self-payment refers to the reimbursement scope but needs to bear a part of the expenses (generally Class B drugs or Class B medical service items, requiring individuals to pay a part, and printing "B 10%" in the drug details on the invoice is 10% of Class B drugs), and personal self-responsibility is the expenses that must be borne by individuals according to the medical insurance policy within the reimbursement scope, which is generally the starting line. Personal responsibility and personal self-pay is a meaning.

It must be different, and the out-of-pocket expenses are borne by oneself and will not be reimbursed. Self-pay is self-paid and can be reimbursed.

Out-of-pocket expenses are relative to public expenses. That is, drugs or items that cannot be reimbursed by public medical care. Out-of-pocket is the part that workers want to pay for.

In both publicly-funded medical care and commercial insurance, there is a minimum payment amount, which can only be reimbursed if it is exceeded, and the part that cannot be exceeded can only be paid by yourself. For example, I remember that the accident medical treatment in commercial insurance can only be reimbursed if it is more than 100, and every time I pay the 100, it will only pay the excess part.