Shenzhen Medical Co-ordination Fund has set an annual maximum payment limit, which is usually about four times the average annual salary of local employees. If the insured's medical expenses exceed this limit within one year, the excess shall be borne by himself. This move aims to reasonably control medical expenses and ensure the long-term stability of the medical insurance fund.
Management and use of medical insurance fund;
1. Raising of medical insurance fund: including unit and individual contributions, government subsidies and other means;
2. Budget management of medical insurance fund: ensure the rational distribution and use of the fund and prevent overspending;
3. The payment scope of medical insurance fund: it usually covers outpatient expenses, hospitalization expenses and drug expenses.
4. Risk control of medical insurance fund: control risks by setting payment limits, auditing fees and other measures;
5. Supervision and audit of the medical insurance fund: conduct regular audits to ensure the safety and transparency of the fund.
To sum up, Shenzhen has set the maximum annual payment limit of the medical insurance pooling fund at about four times the average annual salary of local employees, aiming at reasonably controlling medical expenses and ensuring the long-term stability of the medical insurance fund. Medical expenses exceeding the limit must be borne by the insured.
Legal basis:
People's Republic of China (PRC) social insurance law
second
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to get material help from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
Article 26
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.