Medicare is short for health insurance, and is divided into two main types: social health insurance and commercial health insurance. Usually we pay the urban workers medical insurance, urban and rural residents medical insurance is belong to the social medical insurance.
The so-called social medical insurance belongs to the broad category of social insurance, which is one of the contents of the construction of China's social security system. Social medical insurance is directly managed by the government, take the state, units, individuals **** the same way to establish a medical fund, we personally pay the medical insurance fee is a way of financing the medical insurance fund.
Social medical insurance was established in the spirit of the State Council's Decision on the Establishment of a Basic Medical Insurance System for Urban and Rural Workers and the State Council's Opinion on the Integration of the Basic Medical Insurance System for Urban and Rural Residents, with the former mainly solving the problem of workers' medical insurance and the latter solving the problem of residents' medical insurance.
Employee medical insurance and residents' medical insurance are two different medical insurance systems, but in nature, they are both social medical insurance, and when participants pay for these two kinds of medical insurance, in fact, they can realize the system convergence through the way of mutual transfer.
Compared with the urban workers' medical insurance and the urban and rural residents' medical insurance, due to the different contribution standards and different insured objects, the treatment they enjoy is also different, which is mainly reflected in the reimbursement rate for hospitalization, the reimbursement rate for special outpatient services, the establishment of individual accounts and the return of such aspects. However, the process of hospitalization reimbursement is the same regardless of whether it is employee or resident health insurance.
When a participant is sick and goes to the hospital, the doctor will ask if he has medical insurance. For those who have medical insurance, the medical expenses are usually not advanced by the individual when he is hospitalized. When you are hospitalized, you will need to submit your social security card or ID card to the hospital and pay the threshold fee, which is the starting rate, according to the hospital's regulations.
The threshold is determined by the level of the hospital, which is divided into four levels: township community hospitals, first-level hospitals, second-level hospitals, and third-level hospitals, with the higher the level, the higher the threshold.
Legal basis: Article 2 of the Social Insurance Law of the People's Republic of China (PRC) establishes a social insurance system for basic old-age pension insurance, basic medical insurance, industrial injury insurance, unemployment insurance, and maternity insurance, and guarantees the right of citizens to obtain material assistance from the state and society in accordance with the law in the event of old age, illness, industrial injury, unemployment, and maternity. Article 26 Basic medical insurance for workers, new rural cooperative medical care and basic medical insurance for urban residents shall be carried out in accordance with the provisions of the State. Article 28 in line with the basic medical insurance drug list, diagnostic and treatment items, medical service facilities standards, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.