Core Viewpoint - The article highlights misconceptions surrounding medical insurance policies in China, particularly regarding hospitalization duration, big illness insurance, and the use of personal medical accounts, emphasizing the need for better public understanding of these policies. Group 1: Hospitalization Policies - Many patients are misled to believe that they must be discharged after 15 days of hospitalization due to insurance regulations, which is not true as there is no such policy from the national medical insurance department [1][5] - Medical institutions often pressure patients to leave or transfer based on the false claim that their insurance limit has been reached, which violates insurance agreements [5] Group 2: Big Illness Insurance - Big illness insurance is not limited to specific diseases but is based on the cumulative medical expenses incurred by any illness, allowing for broader coverage [2] - In 2023, 11.56 million people benefited from big illness insurance reimbursements, with an average reduction in out-of-pocket expenses of approximately 8,000 yuan, and the maximum reimbursement can reach hundreds of thousands of yuan [1] Group 3: Medical Account Misconceptions - There is a common misconception that personal medical accounts will be cleared if contributions are suspended for three months; however, the balance remains intact despite any interruptions in payments [5] - The personal medical account consists of current year funds and accumulated balances from previous years, and funds can be used for family members' medical expenses, but the card cannot be lent to others [6][7] Group 4: Direct Settlement for Cross-Province Medical Treatment - The process for direct settlement of medical expenses when seeking treatment outside one's registered area involves prior registration, selecting a designated medical institution, and using an electronic medical insurance card for payment [4] - The direct settlement system has been expanded to cover both outpatient and inpatient services across provinces, enhancing accessibility for patients [8]

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]