1, deductible clause. Deductible clause is one of the main features of medical insurance. In health insurance, deductible is generally used for some medical expenses with lower amount, that is, the insurer is only responsible for the part that exceeds the deductible. On the one hand, the insured can afford lower medical expenses; At the same time, after the deductible is stipulated, a lot of work invested by the insurer can be saved. On the other hand, the provision of deductible can urge the insured to strengthen self-control of medical expenses and avoid unnecessary waste. There are generally three kinds of deductible designs: one is a single indemnity deductible, that is, each indemnity determines a deductible; The second is the annual deductible, that is, according to the total annual compensation, it will be paid only if it exceeds a certain amount; The third is the collective deductible, that is, for group insurance, after the deductible is stipulated, the small medical expenses are borne by the insured and the large medical expenses are borne by the insurer. If it is family insurance, the deductible can be agreed on the basis of the sum of the expenses of all family members.
2. Proportional payment clause. The proportional payment clause is a proportional payment method in which the insurer and the insured share the medical expenses beyond the deductible. This clause is often used on the basis of deductible. In health insurance, because people's health is the subject matter of insurance, there is no question of whether to insure in full. At the same time, because the danger of health insurance is not easy to control, in most health insurance contracts, there are clauses that the insurer pays the medical insurance premium in proportion. Proportional payment can be fixed proportion payment (such as 70% of the insurer and 30% of the insured) or progressive proportion payment, that is, with the increase of actual medical expenses, the proportion borne by the insurer increases and the proportion borne by the insured decreases. This provision is not only conducive to protecting the economic interests of the insured and relieving their worries, but also conducive to the insurer's control of medical expenses.
3. Term of payment. Because the risks of endangering human health are very different, the level of medical expenses is also very different. In order to strengthen the management of health insurance and protect the interests of the insurer and the insured, the maximum amount of medical insurance payment of the insurer is generally restricted to control the total expenditure level. Of course, there may be no compensation limit in the health insurance covering some special serious diseases, but the deductible of this contract is generally higher, and the proportion of the insured is generally higher.
The medical insurance fee is paid by the local social security bureau. The materials required to pay social security are as follows:
1, social insurance registration form, on-the-job employee change roster, and on-the-job employee basic information registration form;
2. Copy of business license (or approval document);
3. A copy of the local tax registration certificate;
4. Copy of organization code certificate;
5. The recent salary roster of the insured unit;
6. Copy of the insured's ID card, and migrant workers are required to provide a copy of the household registration book;
7, the first time to participate in medical insurance personnel to provide a one-inch red background photo.
Legal basis: Article 16 of the Social Insurance Law of People's Republic of China (PRC).
Individuals who participate in the basic old-age insurance will receive the basic old-age pension on a monthly basis if they have paid a total of fifteen years when they reach the statutory retirement age.
Individuals who participate in the basic old-age insurance and pay less than fifteen years when they reach the statutory retirement age can pay for fifteen years and receive the basic pension on a monthly basis; Can also be transferred to the new rural social endowment insurance or urban residents' social endowment insurance, enjoy the corresponding pension insurance benefits in accordance with the provisions of the State Council.
Article 57
The employing unit shall, within 30 days from the date of its establishment, apply to the local social insurance agency for social insurance registration with its business license, registration certificate or unit seal. The social insurance agency shall, within fifteen days from the date of receiving the application, examine and issue the social insurance registration certificate. Where the social insurance registration items of the employing unit are changed or the employing unit is terminated according to law, it shall, within 30 days from the date of change or termination, go to the social insurance agency to handle the change or cancellation of social insurance registration. The market supervision and management department, the civil affairs department and the organization management organ shall promptly inform the social insurance agency of the establishment and termination of the employing unit, and the public security organ shall promptly inform the social insurance agency of the birth, death, household registration, migration and cancellation of the individual.