"医保断缴3个月，个人账户余额就会清零"这一说法在民间广为流传，导致不少参保人员不必要的焦 虑。 职工基本医疗保险的个人账户余额不会因断缴而清零。 个人账户资金是累计计算的，即使断缴也 不会影响账户原有余额的状态。 医保个人账户包括当年度个人账户和往年累计结余账户两部分，当年账户中的剩余资金会自动转入往年 累计结余账户，并且这些资金的本息始终属于参保个人。 断缴医保确实会产生其他后果。 从断缴当月 开始，参保人员将无法享受医保报销待遇，同时医保和生育保险的缴费年限会暂停累计。 如果断缴超 过3个月后再续保，还可能有3-6个月的等待期，且被视为重新参保，重新计算连续参保年限。 "住院满15天必须出院"这一说法在许多医疗机构中流传甚广，甚至被一些医务人员当作"医保规定"向患 者传达。 患者的住院天数和医疗费用应完全取决于病情严重程度，医保部门从未出台任何限制参保患 者住院天数的政策。 医疗机构以"医保额度到了"为由要求患者出院、转院或自费住院，属于违反医保 协议的行为。 "先出院吧，医保规定住院不能超过15天。 "医院病房里，医生对病情尚未完全好转的患者说。 这样的 场景在许多医院上演，患者和家属往往信以为真，只 ...

Core Points - The case of Chen, who suffered a severe pelvic fracture and incurred medical expenses of 138,300 yuan, highlights the critical role of the Urban and Rural Residents Basic Medical Insurance in alleviating financial burdens during health crises [1][3] - The reimbursement process involved basic medical insurance covering 72,600 yuan, which is 60% of the eligible expenses, and additional coverage from critical illness insurance that reimbursed 34,700 yuan, resulting in a total reimbursement of 108,300 yuan, or 78.28% of the total medical costs [2][3] Summary by Sections Medical Insurance Reimbursement Details - Basic medical insurance reimbursed 72,600 yuan, covering 60% of the eligible treatment costs [2] - Critical illness insurance provided an additional reimbursement of 34,700 yuan, covering 59.45% of the high-cost portion [2] - The combined reimbursement from both insurance schemes significantly reduced the financial burden on Chen's family [2] Significance and Implications of Insurance Participation - The case exemplifies the inclusive and protective nature of the Urban and Rural Residents Basic Medical Insurance system [3] - The high reimbursement rate of 78.28% transformed the family's financial anxiety into a sense of security, allowing for focused recovery [3] - The integrated insurance model of basic medical insurance, critical illness insurance, and medical assistance forms a robust safety net for public health [3] - The principle of shared contributions between individuals and government ensures substantial benefits during critical times, reflecting the mutual aid spirit of the insurance system [3] - The insurance system promotes social equity by providing equal access to healthcare benefits for both urban and rural residents [3][4]