Medical insurance co-ordination refers to the remaining part of medical insurance premiums paid by all employers for employees in a co-ordination area after being deducted from personal accounts. The medical insurance pooling fund belongs to all insured persons, and is managed centrally by social insurance agencies and used uniformly. It is mainly used to pay the medical expenses, operation expenses, nursing expenses and basic inspection expenses of the insured employees. The medical insurance fund shall be stored in a special account for special purposes, and no unit or individual may misappropriate it.

The medical insurance pooling fund belongs to the insured, which is stored in a special account and earmarked, and no unit or individual may misappropriate it. The overall fund is mainly used for medical expenses such as hospitalization of insured persons, emergency rescue in non-designated hospitals, referral from different places (hospitals), resettlement in different places, and special disease clinics.

The medical insurance pooling fund is the primary condition to ensure the normal operation of the basic medical insurance system. Once the overall fund is seriously overspent, the guarantee function of the basic medical insurance system will be weakened or even collapsed, which will lead to the failure of the basic medical insurance reform. However, it is an objective and unavoidable fact that the whole fund faces various risks during its operation. Therefore, it is of great practical significance to seriously study and discuss various risks existing in the operation of medical insurance funds, and to avoid and guard against these risks.

legal ground

Article 27 of the Social Insurance Law of People's Republic of China (PRC) * * * If an individual who participates in the basic medical insurance for employees reaches the statutory retirement age and the accumulated payment reaches the fixed number of years stipulated by the state, he will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state. Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations. Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.